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World J Gastrointest Surg. May 27, 2011; 3(5): 59-69
Published online May 27, 2011. doi: 10.4240/wjgs.v3.i5.59
How to assess intestinal viability during surgery: A review of techniques
Linas Urbanavičius, Piet Pattyn, Dirk Van de Putte, Donatas Venskutonis
Linas Urbanavičius, Donatas Venskutonis, Lithuanian University of Health Sciences, Department of General Surgery, Josvainiu str. 2; Kaunas, LT-47144, Lithuania
Piet Pattyn, Dirk Van de Putte, Department of Gastrointestinal Surgery, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
Author contributions: All authors contributed to the conception and design of the manuscript; Urbanavičius L and Van de Putte D drafted the manuscript; Pattyn P and Venskutonis D edited and critically revised the manuscript.
Supported by Research Council of Lithuania
Correspondence to: Linas Urbanavičius, MD, Department of General Surgery, Lithuanian University of Health Sciences. Address: Josvainiu str. 2; Kaunas, LT-47144, Lithuania. ulinas@gmail.com
Telephone: +370 685 75938 Fax: +370 37 306066
Received: November 6, 2010
Revised: March 18, 2011
Accepted: March 25, 2011
Published online: May 27, 2011

Objective and quantitative intraoperative methods of bowel viability assessment are essential in gastrointestinal surgery. Exact determination of the borderline of the viable bowel with the help of an objective test could result in a decrease of postoperative ischemic complications. An accurate, reproducible and cost effective method is desirable in every operating theater dealing with abdominal operations. Numerous techniques assessing various parameters of intestinal viability are described by the studies. However, there is no consensus about their clinical use. To evaluate the available methods, a systematic search of the English literature was performed. Virtues and drawbacks of the techniques and possibilities of clinical application are reviewed. Valuable parameters related to postoperative intestinal anastomotic or stoma complications are analyzed. Important issues in the measurement and interpretation of bowel viability are discussed. To date, only a few methods are applicable in surgical practice. Further studies are needed to determine the limiting values of intestinal tissue oxygenation and flow indicative of ischemic complications and to standardize the methods.

Keywords: Microperfusion, Tissue ischemia, Colon perfusion, Anastomotic leakage, Stoma