Express procedure of intraoperative estimation of viability of small bowel in experiment and clinic

Keywords: small bowel anastomosis; іmpedance; viability of intestine.

Abstract

Objective. Elaboration of effective and informative method of the small intestine viability determination for improvement of the surgical treatment results in pathologies, which need performance of resection of its segments.

Materials and methods. The work is considered as experimentally-clinic one. Its experimental part was conducted on the rats; temporary ischemia was simulated, using application of tourniquet on the intestinal loop, taken from abdominal cavity after doing laparotomy; the animals were distributed on the groups, depending on the ischemia duration applied. Clinical part of the investigation was performed on 68 patients, including a control group of 50 patients, in whom intestinal resection was done, taking into account subjective estimation of the gut viability, and the main group, consisted of 18 patients, in whom intestinal resection was performed, basing on the gut viability estimation data, obtained using the method elaborated.

Results. In the animals, on which temporary noncritical ischemia (up to 10 min) was simulated, the ischemia zone did not differed visually from other intestinal segments, while after persistence of ischemia up to 20- and 25-min the changes have had appeared necrotic with presence of peritonitis. Studying of intestinal specimen in the animals, in whom an acute ischemia was simulated, have shown the mostly expressed changes in endotheliocytes of microcirculatory bed, depending on duration of the ischemia dystrophic changes have been enhanced up to destructive. Total electric resistance (іmpedance) was measured on various frequencies. On all the frequencies, the raising of total electric resistance with more durable ischemia period was observed.

Conclusion. Changes of total electric resistance are reflecting the degree of the blood flow disorder in intestinal wall and may be exploited as a criterion of determination of its viability (capacity of the anastomosis to heal). Objectivization of estimation of the intestinal wall state reduces the quantity of resection of injured intestinal segment and the morbidity.

Author Biographies

M. E. Tymchenko, Zaytsev Іnstitute of General and Urgent Surgery, Kharkiv

Tymchenko Ivanova Mykhailo, MD
Researcher of the Department of comprehensive programming for the development of Urgent surgery and intellectual property protection
Zaytsev Institute of General and Urgent Surgery, Kharkiv
1 Balakireva entrance, Kharkiv, Ukraine, 61103
+380504000832
michael.timchenko@gmail.com
https://orcid.org/0000-0001-8876-5339

Yu. V. Ivanova, Zaytsev Іnstitute of General and Urgent Surgery, Kharkiv

Ivanova Julia, MD, DSci(Med), professor
Chief Researcher of the Department of Surgical Infections
Zaytsev Institute of General and Urgent Surgery, Kharkiv
1 Balakireva entrance, Kharkiv, Ukraine, 61103
dr.ivanova23@gmail.com
https://orcid.org/0000-0001-8773-6827

V. K. Ivanov, O. Ya. Usykov Іnstitute of Radiophysics and Electronics, Kharkiv

Ivanov Victor, DSci, professor
Head of the Laboratory of Remote Sensing of the Earth
Usykov Institute of Radiophysics and Electronics
https://orcid.org/0000-0001-5264-9440

References

Zhebrovsky VV. Abdominal hernia surgery. Moscow: Med. inform. agency; 2005. 384 p. [in Russian]. ISBN: 9-66648-021-2.

Kirienko AI, Nikishkov AS, Seliverstov EI, Andriyashkin AV. Epidemiology of abdominal wall hernias. Endoscopic surgery. 2016;(4:):55-60. [In Russian]. doi: 10.17116/endoskop201622455-60.

Li C, Zhao Y, Han Z, Zhou Y. Anastomotic leaks following gastrointestinal surgery: updates on diagnosis and interventions. Int J Clin Exp Med. 2016;9(3):7031-40.

Меhlnyk VМ, Poyda ОІ. Surgical tactics in insufficiency of the interintestinal anastomoses sutures. Klin khir. 2016;(6):8-12. [In Ukrainian].

Farghaly AE, Ammar MS, Algammal AS, Arafa Ahmed SA. Risk factors for leak in emergent small bowel anastomosis. Menoufia Med J. 2019;32(2):574-80. doi: 10.4103/mmj.mmj_111_18.

Kovalchuk LIa, Hospodarskyi AIa, Husak MO. Intraoperative assessment of intestinal activity in patients with large bowel obstruction. Shpytalna Khirurhiia. 2012;(4):134-5 [In Ukrainian].

Phillips B. Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions. Open Access Surgery. 2016;9:5-14. doi: 10.2147/OAS.S54936.

Peters EG, Dekkers M, van Leeuwen-Hilbers FW, Daams F, Hulsewé KWE, de Jonge WJ, et al. Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial. Colorectal Dis. 2017 Jul;19(7):667-74. doi: 10.1111/codi.13582. PMID: 27943617.

Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017 Mar;43(3):380-98. doi: 10.1007/s00134-016-4665-0. Epub 2017 Feb 6. PMID: 28168570; PMCID: PMC5323492.

Published
2020-10-29
How to Cite
Tymchenko, M. E., Ivanova, Y. V., Ivanov, V. K., & Logachov, V. K. (2020). Express procedure of intraoperative estimation of viability of small bowel in experiment and clinic. Klinicheskaia Khirurgiia, 87(9-10), 74-83. https://doi.org/10.26779/2522-1396.2020.9-10.74
Section
Experimental Investigations