Anastomotic leakage is a serious postoperative complication following a low anterior resection of rectum. Current research in colorectal surgery focuses on searching for techniques which could minimize the risk of leakage. The main objective of this study was to evaluate the impact of cumulative fluid balance on microcirculatory changes at the anastomotic site.This experimental study used 15 domestic pigs; all of the animals underwent rectal resection. Then the animals were divided into three groups and received IV crystalloids at various rates, i.e. 5 ml/kg/h; 10 ml/kg/h; and 20 ml/kg/h. Large bowel micro-perfusion was measured using laser Doppler flowmetry during and following the surgical procedure.The experiments were successfully performed in all 15 cases. No animal died during the procedure or during the follow-up. We found no differences in micro-perfusion of the bowel between the experimental groups during the surgical procedure and during the follow-up period after the surgery. A significant decrease in micro-perfusion was observed after the transection of the inferior mesenteric artery in all the groups; again, no differences between the groups were observed.We did not confirm the original hypothesis that excessive load of IV crystalloids during the surgery would have a negative effect on bowel micro-perfusion and thus a negative effect on the healing of the anastomosis. However, laser Doppler flowmetry was found to have high accuracy in measuring tissue microcirculation and has the potential to be used in clinical practice.

Department for Anaesthesiology Intensive Care and Resuscitation Faculty of Medicine and University Hospital Hradec Králové Hradec Králové Czech Republic

Department of Informatics and Quantitative Methods Faculty of Informatics and Management University of Hradec Králové Hradec Králové Czech Republic

Department of Military Surgery Faculty of Military Health Sciences University of Defence Hradec Králové Czech Republic

Department of Surgery Faculty of Medicine and University Hospital Hradec Králové Sokolská 581 500 05 Hradec Králové Czech Republic

Zobrazit více v PubMed

Meyer J, Naiken S, Christou N, Liot E, Toso C, Buchs NC, et al. Reducing anastomotic leak in colorectal surgery: the old dogmas and the new challenges. World J Gastroenterol. 2019;25:5017–5025. doi: 10.3748/wjg.v25.i34.5017. PubMed DOI PMC

Sciuto A, Merola G, De Palma G, Sodo M, Pirozzi F, Bracale UM, et al. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol. 2018;24:2247–2260. doi: 10.3748/wjg.v24.i21.2247. PubMed DOI PMC

Marjanovic G. Impact of different crystalloid volume regimes on intestinal anastomotic stability. Ann Surg. 2009;249:181–185. doi: 10.1097/SLA.0b013e31818b73dc. PubMed DOI

Rutegard M, Hassmen N, Hemmingsson O, Haapamaki MM, Matthiessen P, Rutegard J. Anterior resection for rectal cancer and visceral blood flow: an explorative study. Scand J Surg. 2016;105:78–83. doi: 10.1177/1457496915593692. PubMed DOI

Šitina M, Turek Z, Černý V, Pařízková R. In situ assessment of the brain microcirculation in mechanically ventilated rabbits using sidestream dark-field (SDF) imaging. Physiol Res. 2011;60:75–81. doi: 10.33549/physiolres.931937. PubMed DOI

Dworkin MJ, Allen-Mersh TG. Effect of inferior mesenteric artery ligation on blood flow in the marginal artery-dependent sigmoid colon. J Am Coll Surg. 1996;183:357–360. PubMed

Boyle NH, Manifold D, Jordan MH, Mason RC. Intraoperative assessment of colonic perfusion using scanning laser Doppler flowmetry during colonic resection. J Am Coll Surg. 2000;191:504–510. doi: 10.1016/S1072-7515(00)00709-2. PubMed DOI

Turek Z, Černý V, Pařízková R. Prolonged hypervolemic hemodilution decreases functional capillary density of ileal mucosa in pigs revealed by sidestream dark-field imaging. J Zhejiang Univ-Sci B. 2011;12:867–874. doi: 10.1631/jzus.B1000385. PubMed DOI PMC

Post IL, Verheijen PM, Pronk A, Siccama I. Intraoperative blood pressure changes as a risk factor for anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2012;27:765–772. doi: 10.1007/s00384-011-1381-7. PubMed DOI PMC

Karliczek A, Benaron DA, Baas PC. Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses. Colorectal Dis. 2010;12:1018–1025. doi: 10.1111/j.1463-1318.2009.01944.x. PubMed DOI

Seike K, Koda K, Saito N, Oda K. Laser Doppler assessment of the influence of division at the root of the inferior mesenteric artery on anastomotic blood flow in rectosigmoid cancer surgery. Int J Colorectal Dis. 2007;22:689–697. doi: 10.1007/s00384-006-0221-7. PubMed DOI

Corbett E, Barry B, Pollard S, Lodge J. Laser Doppler flowmetry is useful in the clinical management of small bowel transplantation. Gut. 2000;47:580–583. doi: 10.1136/gut.47.4.580. PubMed DOI PMC

Tsujinaka S, Kawamura YJ, Tan KY. Proximal bowel necrosis after high ligation of the inferior mesenteric artery in colorectal surgery. Scand J Surg. 2012;101:21–25. doi: 10.1177/145749691210100105. PubMed DOI

Allison AS, Bloor C, Faux W. The angiographic anatomy of the small arteries and their collaterals in colorectal resections: some insights into anastomotic perfusion. Ann Surg. 2010;251:1092–1097. doi: 10.1097/SLA.0b013e3181deb649. PubMed DOI