Intraoperative evaluation of the intestinal wall viability
- Authors: Adamenkov N.A.1,2, Mamoshin A.V.1,3, Dremin V.V.1, Potapova E.V.1, Shupletsov V.V.1, Ivanov Y.V.4, Panchenkov D.N.5, Dunaev A.V.1
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Affiliations:
- Orel State University
- Orel Regional Clinical Hospital
- National Medical Research Center of Surgery named after A. Vishnevsky
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
- Russian University of Medicine
- Issue: Vol 15, No 4 (2024)
- Pages: 46-58
- Section: Reviews
- URL: https://journals.rcsi.science/clinpractice/article/view/278595
- DOI: https://doi.org/10.17816/clinpract633149
- ID: 278595
Cite item
Abstract
An analysis of data from national and foreign literature was carried out in terms of intraoperative determination of the intestinal viability in cases of developing the diseases in the abdominal cavity organs, associated with impaired intestinal blood supply. The basis of this work is the analysis of the modern literature on the methods of intraoperative evaluation of mesenteric ischemia. Impaired mesenteric blood supply is often the consequence of a number of reasons of developing critical conditions (mesenteric thrombosis, acute adhesive intestinal obstruction, incarcerated hernia etc.), also representing a high risk factor for lethal outcomes. Special attention is paid to the occlusion-related pathogenetic mechanism of developing mesenteric ischemia, which is accompanied by rapid development of irreversible morphological changes in the tissues and by significant disorders in the homeostasis systems of the organism. The generally available method for visual evaluation of the intestine viability is not always valid in terms of determining the degree of intensity of the ischemic changes in the intestinal wall. The algorithm of determining the intestine viability includes the determination of the intestine color, the peristaltic motions, the pulsation and the blood filling of mesenteric vessels with dynamic evaluation of these signs after the injecting the local anesthetic drug solution into the mesenterium and after “warming” the intestine with towels soaked in warm sodium chloride solution. In the current surgical conditions, a more precise method is required for intraoperative determination of the tissue viability. For the purpose of the objective evaluation of the intestinal blood supply, the recommendations include using intraoperative ultrasonic and laser Doppler flowmetry, as well as the regional transillumination angiotensometry of the intramural vessels in the small intestine. At the same time, a number of optical spectroscopy and visualization methods show high sensitivity to changes in blood microcirculation without using exogenous contrasting, which can also be successfully used when evaluating the intestinal circulation. According to data from modern literature, there is still controversy on the efficiency of various methods for intraoperative evaluation of disorders of the regional blood microcirculation and the intestine viability, which justifies the conduct of further research works.
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##article.viewOnOriginalSite##About the authors
Nikita A. Adamenkov
Orel State University; Orel Regional Clinical Hospital
Author for correspondence.
Email: nikita-ad@mail.ru
ORCID iD: 0000-0002-0238-2941
SPIN-code: 3348-8250
Russian Federation, Orel; Orel
Andrian V. Mamoshin
Orel State University; National Medical Research Center of Surgery named after A. Vishnevsky
Email: dr.mamoshin@mail.ru
ORCID iD: 0000-0003-1787-5156
SPIN-code: 2553-1200
MD, PhD, Associate Professor
Russian Federation, Orel; MoscowViktor V. Dremin
Orel State University
Email: dremin_viktor@mail.ru
ORCID iD: 0000-0001-6974-3505
SPIN-code: 8990-5396
PhD, Associate Professor
Russian Federation, OrelElena V. Potapova
Orel State University
Email: potapova_ev_ogu@mail.ru
ORCID iD: 0000-0002-9227-6308
SPIN-code: 9315-8770
PhD, Associate Professor
Russian Federation, OrelValery V. Shupletsov
Orel State University
Email: valery.shupletsov@bmecenter.ru
ORCID iD: 0009-0006-0024-8518
SPIN-code: 5964-9055
Russian Federation, Orel
Yuri V. Ivanov
Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
Email: ivanovkb83@yandex.ru
ORCID iD: 0000-0001-6209-4194
SPIN-code: 3240-4335
MD, PhD, Professor
Russian Federation, MoscowDmitry N. Panchenkov
Russian University of Medicine
Email: dnpanchenkov@mail.ru
ORCID iD: 0000-0001-8539-4392
SPIN-code: 4316-4651
MD, PhD, Professor
Russian Federation, MoscowAndrey V. Dunaev
Orel State University
Email: dunaev@bmecenter.ru
ORCID iD: 0000-0003-4431-6288
SPIN-code: 8128-3093
PhD, Associate Professor
Russian Federation, OrelReferences
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