Implementation of intraoperative procedures to prevent anastomotic leak in low anterior rectal resections: a pilot study for a novel technique to evaluate anastomotic vascularization

Introduction: Altered vascular microcirculation is recognized as a risk factor for anastomotic leakage (AL) in colorectal surgery. However, few studies evaluated its impact on AL using different devices, with heterogeneous results. The present study reported the initial experience measuring gut microcirculatory density and flow with the aid of incidence dark-field (IDF) videomicroscopy (Cytocam, Braedius, Amsterdam, The Netherlands) comparing its operative outcome using a propensity score matching (PSM) model based on age, gender, and Charlson Comorbidity Index (CCI). Materials and methods: Videos from 5 different sites (at least 10 s/site) were recorded from both the mucosal and serosal site of the left colon end after the colonic resection. Total vessel density (TVD), Perfused Vessel Density (PVD), De Backer score, Proportion of Perfused Vessels (PPV), and Microvascular Flow Index (MFI) were analyzed. At each recording, noninvasive measurements of blood pressure, heart rate, temperature, use of vasoactive drugs, and peripheral oxygen saturation were simultaneously recorded. The association between postoperative outcomes and microcirculation evaluation was investigated using PSM analyses. Results: Ninety-nine patients were included in the Cytocam group. The mean TVD small was 8.9 ± 2.8 mm/mm2, the PPV small % was 100 in all patients but 1, while the MFI was 3 in all patients. The mean PVD small was 8.76 ± 2.8 mm/mm2 and the mean De Becker score was 4.4 ± 1.3. In 2 patients (10.5%), the finding of altered vascularization resulted in the change of the operative strategy with an extension of the resection point. AL occurred in 2 patients of the No Cytocam group (p = 0.811). Conclusion: This type of anastomotic evaluation has shown to be feasible, safe, and useful in easily detecting any alteration of the resected colon before anastomotic construction. Moreover, this technology could offer a more cost-effective manner than other devices.