title: High tie versus low tie in rectal surgery: comparison of anastomotic perfusion.
abstract: OBJECTIVE
  Both "high tie" (HT) and "low tie" (LT) are well-known strategies in rectal surgery. The aim of this study was to compare colonic perfusion after HT to colonic perfusion after LT.
  
  
  METHODS
  Patients undergoing rectal resection for malignancy were included. Colonic perfusion was measured with laser Doppler flowmetry, immediately after laparotomy on the antimesenterial side of the colon segment that was to become the afferent loop (measurement A). This measurement was repeated after rectal resection (measurement B). The blood flow ratios (B/A) were compared between the HT group and the LT group.
  
  
  RESULTS
  Blood flow was measured in 33 patients, 16 undergoing HT and 17 undergoing LT. Colonic blood flow slightly decreased in the HT group whereas the flow increased in the LT group. The blood flow ratio was significantly higher in the LT group (1.48 vs. 0.91; p = 0.04), independent of the blood pressure.
  
  
  CONCLUSIONS
  This study shows the blood flow ratio to be higher in the LT group. This suggests that anastomoses may benefit from better perfusion when LT is performed.
authors: Department of Surgery, University Medical Center Rotterdam, Erasmus MC, Rotterdam, The Netherlands. nielskomen@hotmail.com
authors: Niels
authors: N
authors: Komen
authors: Juliette
authors: J
authors: Slieker
authors: Peter
authors: P
authors: de Kort
authors: J H W
authors: JH
authors: de Wilt
authors: Erwin
authors: E
authors: van der Harst
authors: Peter-Paul
authors: PP
authors: Coene
authors: Martijn P
authors: MP
authors: Gosselink
authors: Martijn
authors: M
authors: Gosselink
authors: Geert
authors: G
authors: Tetteroo
authors: Eelco
authors: E
authors: de Graaf
authors: Ton
authors: T
authors: van Beek
authors: Rene
authors: R
authors: den Toom
authors: Wouter
authors: W
authors: van Bockel
authors: Cees
authors: C
authors: Verhoef
authors: Johan F
authors: JF
authors: Lange
mesh_terms: D000714:Anastomosis, Surgical; D001775:Blood Circulation / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000098:blood supply* / Q000503:physiopathology / Q000601:surgery*