Clinical Study on Blood Flow of Anastomotic Region during Anterior Resection of Rectal Cancer

Shinji Yamamoto, Hidetaka Mochizuki, Kazuo Hase, Sachio Yokoyama, Yoshihide Ushitani, Tetsuhisa Yamamoto, Toshimasa Yatsuoka, Shinya Bekku, Shoetsu Tamakuma

Department of Surgery 1 of National Defense Medical College

The adequacy of high ligation of the inferior mesenteric artery (IMA) during low anterior resection of the rectum was evaluated by intraoperative laser doppler flowmetry in 38 patients with rectal cancer. With the probe sutured to the colonic wall, blood flow was measured at the serosal side of the sigmoid colon, 1 cm anal to which anastomosis was planned. The average blood flow was 24.7 ml/min/100 g tissue, which was measured soon after laparotomy. On clamping both the IMA and the left colic artery the blood flow reduction rate was 16%, which was significantly greater than 9% on clamping the superior rectal artery only (p<0.05). In patients with Riolan arcade (RA), blood flow remained almost unchanged by clamping the involved arteries, while in patients without RA the reduction rate was 25% with a significant difference (p<0.001). Although blood flow was reduced both in the high ligation group and the low ligation group after the anastomosis was performed with involved arteries ligated and divided, no significant difference in the reduction rate was noticed irrespective of the ligation site and the presence or absence of Riolan arcade. On the ground that no anastomotic dehiscence was observed in any of patients with high ligation of the IMA, high ligation of IMA may safely be performed on the basis of appropriately preserved blood flow at the oral side of the anastomosed colon, regardless of the presence of RA.

Key words
adequacy of high ligation of the inferior mesenteric artery, low anterior resectin of the rectum, intraoperative laser doppler flowmetry, Riolan arcade, blood flow of anastomotic region

Reprint requests
Shinji Yamamoto Department of Surgery 1 of National Defense Medical College
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
May 13, 1992

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