|
|
Back to 2018 Posters
DIFFERENT TECHNIQUES OF MICRODIALYSIS IN MONITORING OF ISCHEMIA IN COLORECTAL ANASTOMOSIS - EXPERIMENTAL STUDY
Ondrej Ryska*1,2, Jaroslav Kalvach3,2, Jaroslav Pazin3,2, Jan Hadac3,2, Stefan Juhas2, Jana Juhasova2, Jan Martinek4,2
1University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, United Kingdom; 2Institute of Animal Physiology and Genetics, Czech Academy of Science, Libechov, Czechia; 3Department of Surgery, 2nd Faculty of Medicine and Military University Hospital, Prague, Czechia; 4Institute for Clinical and Experimental Medicine, Prague, Czechia
Background
Inadequate blood supply is one of the major risk factors for colorectal anastomotic leak. Early postoperative detection of ischemic changes can predict complicated healing and lead to better outcome (1). Microdialysis (MD) offers real-time evaluation of adequate bowel perfusion through monitoring of tissue metabolism. To date, most studies tested intraperitoneal MD which reflects predominantly intraabdominal inflammatory changes as a consequence of already developed leak (2).
The aim of this study was to assess the feasibility of MD for early detection of ischemic changes in colorectal anastomosis and to compare intra- and extramural MD.
Materials and Method
Five pigs with end-to-end colorectal anastomosis were included. Two 1 mm thin MD catheters were placed intramurally and on serosal surface 0,5 cm from distal anastomotic edge. Occlusive ischemia of anastomosis was induced after 3 measurements, followed by another 3 hours of monitoring.
Tissue levels of glucose, pyruvate, lactate and glycerol were measured every 60 minutes before and after ischemia induction. Systemic homeostasis was maintained with balanced crystalloids or glucose if necessary. Data are presented as medians with ranges and Mann-Whitney test was used to compare pre- and post-ischemic changes and values from intra- and extramural catheters. The study was performed after approval from local ethical committee and in accordance with the European Convention on Animal Protection and Guidelines on Research Animal Use. Supported by AZV16-31806A, MO1012, LO1609.
Results
Significant changes caused by local ischemia were observed in decreased levels of glucose - 3,3 (0,2-9,9) vs. 0 (0-1,4) mmol/l; (p<0,0001) or pyruvate - 225 (38-394) vs. 58,5 (1-619) umol/l; (p<0,0001) and increased levels of lactate - 6,3 (1,8-9,6) vs. 13,2 (3,5-20,9) mmol/l; (p<0,0001) and glycerol 34 (3-112) vs. 126 (15-322) umol/l (p<0,0001). There was no significant difference (p>0,05) in pre- and postischemic values obtained from intramural and serosal catheter. All metabolic changes were detectable already in first samples 60 minutes after ischemia induction.
Conclusion
Postoperative ischemic changes in colorectal anastomosis can be detected by means of MD. Non-invasive serosal monitoring was as effective as intramural catheter and this technique is ready for clinical testing.
References
1 - Rullier E, Laurent C, Garrelon JL et al. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 1998;85:355-8.
2 - Sabroe JE, Ellebæk MB, Qvist N. Intraabdominal microdialysis - methodological challenges. Scand J Clin Lab Invest. 2016 Dec;76(8):671-677.
Back to 2018 Posters
|
