Laser Doppler blood flow measurement in rectal resection for carcinoma--comparison between the straight and colonic J pouch reconstruction.

Abstract

Lower rates of anastomotic leakage have been reported after rectal resection with a colonic pouch-anal anastomosis than with a conventional straight anastomosis. The microcirculation in the bowel segment that was used for construction of a colonic pouch or a conventional straight anastomosis was examined. Transmural colonic blood flow was measured by laser Doppler flowmetry during the operation before the construction of a straight (n = 16) or pouch (n = 14) anastomosis. The blood flow recordings were first done before dissection of the bowel at one point close to the planned bowel end and at another point 8 cm more proximally. A second recording was done at the same sites after dissection and, where appropriate, after construction of the pouch, but before the anastomosis was completed. In the straight group (end-to-end anastomosis), blood flow levels at the site intended for the anastomosis were significantly decreased following dissection of the bowel. In the pouch group (side-to-end anastomosis), blood flow levels at the site of the anastomosis were similar following dissection of the bowel and pouch construction. It is concluded that unaffected blood flow at the site of the anastomosis of the pouch may be a favourable factor for anastomotic healing.