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Results of postoperative microdialysis intraperitoneal and at the anastomosis in patients developing anastomotic leakage after rectal cancer surgery
Örebro University, School of Medical Sciences. Department of Surgery, Colorectal Unit.ORCID iD: 0000-0003-2789-8001
School of Rudbeck, Örebro, Sweden.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department ofCardiothoracic and Vascular Surgery.
Department of Vascular Surgery, Institute of Medicine, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
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2019 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 54, no 10, p. 1261-1268Article in journal (Refereed) Published
Abstract [en]

Introduction: Anastomotic leakage postoperatively in patients operated with rectum resection and primary anastomosis is a common and feared complication. We have studied seven patients with an anastomotic leakage after surgery and compared them with 13 patients without complications.

Methods: Metabolic measurements with microdialysis were done during the first seven postoperative days, with measurements of glucose, pyruvate, lactate and glycerol. The lactate/pyruvate ratio was calculated. Measurements were performed subcutaneously, intraperitoneally and at the anastomosis. The inflammatory cytokines, IL 6 and IL 10, were measured intravenously and intraperitoneally 48 hours postoperatively.

Results: Intravenous and intraperitoneal IL 6 were higher in the leakage group. Around the small intestine (intraperitoneally), we found that patients developing anastomotic leakage had higher lactate and lactate/pyruvate ratio immediately after surgery. They also showed lower glycerol levels. At the anastomosis, we found higher lactate and lactate/pyruvate ratio in anastomotic leak patients after the fourth postoperative day.

Conclusions: The results indicate that a possible mechanism behind an anastomotic leakage is an impaired circulation and thus insufficient saturation to the small intestine peroperatively. This develops into an inflammation both intraperitoneally and intravenously, which, if not reversed, spread within the gastrointestinal tract. The colorectal anastomosis is the most vulnerable part of the gastrointestinal tract postoperatively and hypoxia and inflammation may occur there, and an anastomosis leakage will be the consequence.

Place, publisher, year, edition, pages
Taylor & Francis, 2019. Vol. 54, no 10, p. 1261-1268
Keywords [en]
Rectal surgery, anastomotic leakage, intraperitoneal microdialysis, lactate pyruvate ratio, intraperitoneal cytokines
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-77758DOI: 10.1080/00365521.2019.1673476ISI: 000491462900001PubMedID: 31630578OAI: oai:DiVA.org:oru-77758DiVA, id: diva2:1368020
Note

Funding Agencies:

Research Committee of Region Örebro County at Örebro University Hospital  

Nyckelfonden at Örebro University Hospital 

Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-21Bibliographically approved

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Oikonomakis, IoannisHörer, Tal M.Nilsson, Kristofer F.
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