Historical and modern intraoperative methods for determining the viability of the anastomosed ends of the colon

Abstract

Determination of the viability of the anastomosed ends of the intestine is the most important stage in operations on the gastrointestinal tract, since their insufficient blood supply leads to formidable complications in the form of necrosis of the intestinal wall, failure of the anastomotic sutures and peritonitis. Visual methods for determining viability by peristalsis, pulsation of marginal vessels, color of the serous cover are very subjective and depend both on the experience of the surgeon and on the conditions in which operations are performed. The development of colorectal surgery is continuously associated with the study and development of methods for intraoperative determination of the viability of the anastomosed ends of the intestine. This review is devoted to various instrumental methods for determining the level of vascularization of the colon walls. The review presents data from both experimental and clinical studies, which reflect the advantages and disadvantages of these methods, allowing us to conclude that they can be used in practice. Among the most well-known methods for assessing the microcirculation of the intestinal wall during surgery, from experimental to applied, most authors single out laser Doppler fluorometry as the most modern and informative method. However, there is no consensus on its feasibility and effectiveness. Other methods for assessing microcirculation are inappropriate due to the complexity of their implementation or inefficiency. Despite this circumstance, among all the methods, perfusion fluorometry and laser fluorescein angiography compare favorably, especially the latter, since it allows to more accurately determine the state of the intestine and is rather undemanding in execution. A less accurate, but more accessible method is Doppler ultrasound, since it does not require large financial resources.