Ist die Durchblutung des ileokolischen Interponates nach Ösophagusresektion regelhaft ausreichend für eine Anastomose?
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Philipps-Universität Marburg
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Abstract
Introduction:
In esophageal surgery the use of the left hemicolon as an esophageal replacement is recommended if the stomach is not available. The preference for the left hemicolon for interposition does not only have a traditional surgical background. It is argued, among other things, that the left hemicolon has less anatomical variability than the right hemicolon.
The goal of the study is to assess the perfusion of the right colon and terminal ileum preserving the ileocolic valve as a reflux barrier for use as a gastric and esophageal substitution.
Material und methods:
A prospective observational study on 20 patients with indication for right hemicolectomy was performed to assess the perfusion of the ileocolic segment. A right hemicolectomy in complete mesocolic excision (CME) technique with transection of the ileocolic vessel trunk, the ileal mesenterium and the wall of the ileum and transverse colon was performed in all patients previously to judgement of the bowel wall perfusion. Prior to transection of its final blood supply by the right branches of the middle colic artery, perfusion of the bowel wall tissue was analyzed by several methods including ICG-perfusion measurement (Image1S, Karl-Storz GmbH ©, VITOM Kamera) and surgeons assessment intraoperatively and postoperatively using video documentation.
Results:
In all 20 patients there was identical perfusion of the different ends following bowel transection. There was no difference between the different assessment methods. In all 20 patients, the specimen bowel perfusion was sufficient for performing bowel anastomoses prior to transection of the blood supply offered by the middle colic artery. No anastomotic leak appeared during this study.
Conclusion:
There is a reliable perfusion of the terminal ileum of the ileocolic segment pedunculated by the middle colic vessels preserving the antirefluxive ileocolic valve. Due to this good perfusion, our study indicates that the right colon with preservation of the ileocaecal valve - as reflux barrier - can be preferred to the left for esophageal substitution if a colon interposition is necessary.
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Dates
Created: 2018Issued: 2018-10-22Updated: 2018-10-22
Faculty
Medizin
Publisher
Philipps-Universität Marburg
Language
ger
Data types
DoctoralThesis
Keywords
ICG-fluoresenceileocolic interpositionoesophageal interposition
DFG-subjects
ICG-FluoreszenzPerfusion re HemikolonÖsophagusInterposition rechtes HemikolonIleozäkalklappeNIR-Fluoreszenz
DDC-Numbers
610
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Galanis, Michail: Ist die Durchblutung des ileokolischen Interponates nach Ösophagusresektion regelhaft ausreichend für eine Anastomose?. : Philipps-Universität Marburg 2018-10-22. DOI: https://doi.org/10.17192/z2018.0421.