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2007 Program and Abstracts | 2007 Posters
Intra-Operative Assessment of Tissue Viability
L. Albert Wetter*, Barry Sanchez, Pamela Foster
Surgery, Mills-Peninsula Hospital, Burlingame, CA

Assessment of gut perfusion is vital to prevent anastomotic disruption or strictures following bowel resection. If available during surgey, the risk of ischaemic problems would be reduced. We measured superficial tissue oxygenation and perfusion using a continuous, noninvasive localized visible light spectrophotometer in patients undergoing gastric bypass to assess it effectiveness.Study design:A prospective non-randomized feasibility study to measure jejunal, gastric pouch serosal and mucosal oxygenation with an FDA-approved visible light spectrophotometer (T-Stat®, Spectros, Portola Valley, CA) was done in patients undergoing Roux-Y gastric bypass. Sterile laparoscopic 2 mm probes were used. All patients were followed at 1, 6 weeks, 3 months post-surgery and checked for anastomotic leaks and strictures. Results22 patients were entered in the study. There were no intraoperative complication from using the device. No patients had leaks, or strictures (early or late) in the series. Two cases of jejunal ischaemia due to stapling of the jejunal mesenteric arteries too close to the bowel was successfully detected by the system. Resection of these segment prior reanastomosis was performed with an uneventful outcome in both cases. Capillary oxygen saturation greater than 40% seems to be a safe minimal level for serosal oxygenation. Oxygen saturation prior and after the anastomosis did not differ substantially in the series.ConclusionSuperficial tissue oxygenation measurement using visible light is an effective tool to assess tissue viability and ensure successful healing of gastro-intestinal anastomosis. The limited tissue penetration of visible light reflects capillary oxygenation at the healing site. Deeper spectroscopy measurement may result in an overestimate oxygen saturation as arterial saturation is included. A capillary oxygen saturation above 40% appears to be safe to prevent anastomotic disruption or ischemia. Intraoperative visual light spectroscopy measurements of tissue oxygenation may assist the surgeon to assess tissue viability on performing bowel anastomosis, helping to ensure successful healing.
Capillary Oxygen Saturation (N=22)

Operative Stage Location Average (% O2 sat.) SD Location Average (% O2 sat.) SD
Initial jejunal measure Jejunal serosa 68.0 6.2 Distal Jejunum 57.1 16.9
Post jejunal division Jejunal serosa 60.6 12.2
Jejunal mucosa 42.4 15.6
Post jejuno-jejunostomy Jejunal serosa 53.3 14.8
Stomach serosa prior division 62.3 9.2 Distal Jejunum in upper abdo. 60.6 14.3
serosa post division 48.1 16.3
serosa post anastomosis 50.9 12.1 Jejunal limb post gastro-jejunostomy 55.7 11.9

2007 Program and Abstracts | 2007 Posters
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