Intraoperative assessment of microperfusion with visible light spectroscopy for prediction of anastomotic leakage in colorectal anastomoses

Purpose Anastomotic leakage is associated with increased morbidity and mortality. However, there is no accurate tool to predict its occurrence. We evaluated the predictive value of visible light spectroscopy (VLS), a novel method to measure tissue oxygenation [saturated O-2 (StO(2))], for anastomotic leakage of the colon and the rectum. Method Oxygen saturation in the bowel was measured in 77 colorectal resections. The anastomosis was between 2 and 30 cm (mean 13 cm) from the anal verge. The oxygen saturation was measured in the colon and rectum before and after anastomosis construction. This was compared with a reference measurement in the caecum. Data on postoperative complications were prospectively collected. Results Anastomotic leakage occurred in 14 (18%) patients. When compared with a leaking anastomosis, normal anastomoses showed rising O-2 values during the operation (mean StO(2) 72.1 +/- 9.0-76.7 +/- 8.0 vs 73.9 +/- 7.9-73.1 +/- 7.4) (P < 0.05). There were also higher StO(2) values in the caecum compared with those which ultimately leaked (73.6 +/- 5.7 normal anastomoses, 69.6 +/- 5.6 anastomotic leaks) (P < 0.05). Both StO(2) values were predictive of anastomotic leakage. Conclusion Tissue oxygenation O-2 appears to be a potentially useful means of predicting anastomotic leakage after colorectal anastomosis.