Abstract
It is often technically difficult to anastomose the colon near the peritoneal reflection with apprehension regarding severe ischemia in the distal colon after extended left-sided hemicolectomy. This study was designed to investigate how far proximally from the peritoneal reflection the middle and inferior rectal arteries can nourish the distal colon after the high ligation of the infererior mesenteric artery on extended left-sided hemicolectomy.
Viability of the ischemic colon and the critical level of ischemia for safe colonic anastomosis were studied experimentally with both fluorescence pattern and tissue partial oxygen tension (PtO2) five minutes after producing ischemia. The ischemic colon with no fluorescence pattern (PtO2 16 mmHg) was not viable. Ischemic colons showing normal (PtO2 52 mmHg), fine patchy (PtO2 41 mmHg), or coarse patchy pattern (PtO2 27 mmHg) showed satisfactory anastomosic healing.
Observations in nine patients undergoing extended left-sided hemicolectomy revealed sufficient blood flow for anastomosis in the distal colon up to 20 cm from the peritoneal reflection and even higher in some case.
