Criteria and monitoring of gastric and duodenal viability

Abstract

Functional and organic stomach pathology is associated with local disturbances of hemomotorodynamics [1,6]. These disturbances determine both reversible and irreversible intramural ischemia and, finally, the vital functions and viability of the compromised stomach parts [2]. The viability criteria of compromised stomach parts have not been elaborated yet because of the absence of a technique allowing atraumatic and adequate assessment of hemodynamics simultaneously with the monitoring of the motor functions of the compromised stomach parts [3,7]. Therefore, the atraumatic and informative technique is needed to record these essential functions.The purpose of this study was to elaborate adequate criteria for the viability of different stomach parts and the duodenum bulb by means of transilluminational pulsomotorography described earlier [4]. This method is based on recording the changes in the pulse and nonpulse levels of the optical density of the pulsing bloodstream and motor activity of hollow organs. Changes in the optical densities of organs were recorded by means of an optic pair consisting of light-emitting diods and photosensors connected with a graphic recording device amplifying the recorded signals. The parameters of local hemomotorodynamics were recorded in pulsomotorograms. The following hemodynamic parameters were determined from pulsemotorograms: the amplitude of pulse oscillations (APO) in millimeters and indices of local motility, including the amplitude of the motor wave (AMW) in millimeters and the period of the motpr wave (PMW) in seconds. Investigations were carried out during fibrogastroscopy; the parameters of hemomotorodynamics were determined in the pyloro-antral part, the greater and lesser curvatures of stomach, the subcardial part, and the duodenum bulb. The significance of mean statistical values was determined using Student's t test. The technique may be used during a surgical operation and intraluminally without operative intervention. In addition, this technique allows the continuous atraumatic monitoring of the viability of hollow organs and its timely and effective correction. In combination with the traditional methods used for studying different stomach functions, such as roentgenography and ultrasonography, our technique gives a complete functional physiological picture of the organ.Laparotomy without any additional interventions was performed in 18 dogs; hemomotorodynamic parameters of the greater curvature of stomach were recorded in three parts of the stomach [5]. The largest APO value measured in the greater curvature 5 cm proximally of the pyloric sphincter was 8.2 ± 1.91 mm. The smallest value was 4.7 ± 0.88 mm in the proximal part of the greater curvature 3-4 cm higher than upper pole of the spleen. The motor activity of the greater stomach curvature was maximum in the antral part of the greater curvature (27.0 ± 3.17 mm) and it was minimum in the middle of the greater curvature (20.9 ± 1.82 mm). Thus, in the experiment on the greater stomach curvature, pulsing bloodstrea...