Detection of inadequate anastomotic perfusion with handheld vital microscopy in two patients during colorectal surgery
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CASE REPORT
Detection of inadequate anastomotic perfusion with handheld vital microscopy in two patients during colorectal surgery Arthur L. M. Tavy1 · Anton F. J. de Bruin1 · Mat van Iterson1 · Anke B. Smits2 · E. Christaan Boerma3 · Can Ince4 · Peter G. Noordzij1 · Djamila Boerma2 Received: 23 June 2020 / Accepted: 6 September 2020 © Japanese Society of Gastroenterology 2020
Abstract Introduction Anastomotic leakage is one of the most feared complications after gastrointestinal surgery. Assessment of anastomotic viability during surgery remains challenging. Sufficient bowel tissue perfusion is a requisite for anastomotic healing. Handheld vital microscopy (HVM) is a non-invasive technique that can directly visualize the intestinal microcirculation during surgery. Presentation of two cases Two patients underwent elective laparoscopic colorectal surgery. During surgery HVM was used to assess bowel perfusion prior to creation of a primary anastomosis. Although the bowel macroscopically appeared to be well perfused, HVM showed a severely compromised microcirculation. The colon was re-internalized and during the following minutes cyanosis of the bowel occurred which was visually determined by the surgeon. After dissection towards cranially, a new site for the primary anastomosis was chosen. The postoperative period was uncomplicated. Discussion Sufficient bowel tissue perfusion is often mentioned as key in the pathophysiology of anastomotic leakage. HVM is a technique that could potentially aid surgeons in the assessment of microcirculatory perfusion of the bowel during surgery. Conclusion We report two cases undergoing colorectal surgery in which HVM showed merit in detecting compromised bowel perfusion before creation of a primary anastomosis. Keywords Intestinal microcirculation · Surgery · Anastomotic leakage · Handheld vital microscopy · Colorectal cancer
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12328-020-01235-z) contains supplementary material, which is available to authorized users. * Arthur L. M. Tavy [email protected] 1
Department of Anesthesiology, Intensive Care and Pain Medicine, St. Antonius Hospital, Postbus 2500, 3430 EM Nieuwegein, The Netherlands
2
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
3
Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands
4
Department of Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
Anastomotic leakage (AL) is a feared complication after gastrointestinal surgery. Patients with AL have higher rates of morbidity and hospital mortality [1]. Although risk factors for AL have been described, assessment of anastomotic viability during surgery remains challenging [2]. Sufficient bowel tissue perfusion is a requisite for anastomotic healing. Techniques that can aid surgeons in the assessment of bowel perfusion during surgery could potentially aid in the quest to reduce
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