Colorectal Intramural Blood Supply and Microcirculation in Man

Fallouji, M. A. R. Al

doi:10.1007/978-3-642-79260-1_2

Cited by 1 publication

(1 citation statement)

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“…Nevertheless, because the marginal vessels are the blood vessels closest to the anastomosis, evaluating the marginal vessels could be the most clinically feasible approach. The experiment of Allison et al 19 found that collaterals between the vasa recta could occur both extramurally as well as intramurally and Fallouji et al 20 showed that the mucoso-submucosal area received about two thirds of the incoming blood flow and seromuscular area received about one third of the incoming blood flow by dynamic flowmetry. Secondly, this method evaluated only the blood supply of the proximal end and did not consider the blood supply of the distal end, which is www.nature.com/scientificreports/ also important for a safe anastomosis.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative perfusion assessment of the proximal colon by a visual grading system for safe anastomosis after resection in left-sided colorectal cancer patients

Ryu

Lim

Choi

et al. 2021

Sci Rep

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We aimed to evaluate the clinical feasibility of a new visual grading system. We included 50 patients who underwent resection of primary colorectal cancer. Before anastomosis, the marginal vessel was cut and the perfusion status was assessed by a visual grading system. The visual grading system is comprised of five grades according to the bleeding from the marginal vessel and is categorized into 4 groups: good (grade A and B), moderate (grade C), poor (grade D) and none (grade E). Colorectal anastomosis was performed only in the good and moderate groups. We compared postoperative outcomes between the good and moderate groups and analysed the factors affecting the perfusion grade. Among the patients, 48% were grade A, 12% were grade B, and 40% were grade C. There was no anastomotic leakage. Only one patient with grade C showed ischemic colitis and needed reoperation. Age was the only factor correlated with perfusion grade in multivariate analysis (OR 1.080, 95% CI 1.006–1.159, p = 0.034). The perfusion grades were significantly different between > 65 and < 65 year-old patients (> 65, A 29.2% B 12.5% C 58.3% vs. < 65, A 65.4% B 11.5% C 23.1%, p = 0.006). Our intraoperative perfusion assessment that uses a cutting method and a visual grading system is simple and useful for performing a safe anastomosis after colorectal resection. If the perfusion grade is better than grade C, an anastomosis can be performed safely. Age was found to be an important factor affecting the perfusion grade.

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Section: Discussionmentioning

confidence: 99%