title: Postoperative Hemodynamic Index Measurement With Miniaturized Dynamic Light Scattering Predicts Colorectal Anastomotic Healing.
abstract: BACKGROUND
  Perioperative bowel perfusion (local hemodynamic index [LHI]) was measured with a miniaturized dynamic light scattering (mDLS) device, aiming to determine whether anastomotic perfusion correlates with the anastomotic healing process and whether LHI measurement assists in the detection of anastomotic leakage (AL) in colorectal surgery.
  
  
  METHODS
  A partial colectomy was performed in 21 male Wistar rats. Colonic and anastomotic LHIs were recorded during operation. On postoperative day (POD) 3, the rats were examined for AL manifestations. Anastomotic LHI was recorded before determining the anastomotic bursting pressure (ABP). The postoperative LHI measurements were repeated in 15 other rats with experimental colitis. Clinical manifestations and anastomotic LHI were also determined on POD3. Diagnostic value of LHI measurement was analyzed with the combined data from both experiments.
  
  
  RESULTS
  Intraoperative LHI measurement showed no correlation with the ABP on POD3. Postoperative anastomotic LHI on POD3 was significantly correlated with ABP in the normal rats (R(2) = 0.52; P < .001) and in the rats with colitis (R(2) = 0.63; P = .0012). Anastomotic LHI on POD3 had high accuracy for identifying ABP <50 mm Hg (Area under the curve = 0.86; standard error = 0.065; P < .001). A cutoff point of 1236 yielded a sensitivity of 100% and a specificity of 65%. On POD3, rats with LHIs <1236 had significantly higher dehiscence rates (40% vs 0%), more weight loss, higher abscess severity, and lower ABPs (P < .05); worse anastomotic inflammation and collagen deposition were also found in the histological examination.
  
  
  CONCLUSIONS
  Our data suggest that postoperative evaluation of anastomotic microcirculation with the mDLS device assists in the detection of AL in colorectal surgery.
authors.affiliation: Erasmus University Medical Center, Rotterdam, Netherlands Peking University Cancer Hospital and Institute, Beijing, China wuzhouqiao@gmail.com.
authors.forename: Zhouqiao
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Geesien S A
authors.initials: GS
authors.lastname: Boersema
authors.affiliation: Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Diman
authors.initials: D
authors.lastname: Taha
authors.affiliation: Elfi-Tech Co Ltd, Rehovot, Israel.
authors.forename: Ilya
authors.initials: I
authors.lastname: Fine
authors.affiliation: Academic Colorectal Center, Havenziekenhuis, Rotterdam, Netherlands.
authors.forename: Anand
authors.initials: A
authors.lastname: Menon
authors.affiliation: Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Kleinrensink
authors.affiliation: Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Jeekel
authors.affiliation: Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Johan F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000000981:diagnostic imaging*; D000818:Animals; D003106:Colon / Q000601:surgery*; D000067493:Dynamic Light Scattering / Q000379:methods*; D007091:Image Processing, Computer-Assisted; D008297:Male; D051381:Rats; D017208:Rats, Wistar; D012007:Rectum / Q000601:surgery*; D012680:Sensitivity and Specificity; D014945:Wound Healing / Q000502:physiology*
keywords: anastomotic leakage; colorectal surgery; early detection; ischemia; perfusion; real-time monitor