JEFFREY W MILSOM, MD FACS, RAGHAVA S PAVOOR, MD, PARUL J SHUKLA, MD. Weill Cornell Medical College/New York Presbyterian Hospital
Background: Adequate vascularity of the bowel is a key determinant of successful anastomoses. Surgeries involving creation of a colorectal anastomosis are technically challenging due to the anatomical complexity of the pelvis and difficulty associated with operating within the confines of the bony pelvis. In such a challenging environment, there is always a further need for better evaluation tools that help the surgeon in intraoperatively evaluating the colorectal anastomosis.
Aims/Objectives: To assess the role of Narrow Band Imaging in evaluating the vascularity of bowel anastomoses.
Methods: Retrospective review was performed on 17 patients who received a stapled colorectal anastomosis from 1/21/2010 to 9/7/2010 and were evaluated with the OlympusTM High Definition Video Colonoscope (Model: CF-H180AL) in addition to the air-insufflation leak test. The anastomoses were evaluated for bleeding, anastomotic defect at time of stapling and integrity of the staple line and visualized under White Light and Narrow Band Imaging. Images of the anastomoses were evaluated.
Results: We appreciated three shades of green (Green 1, Green 2, and Green 3). On evaluating the NBI pictures, we could appreciate varying patterns of vascularity (corresponding to the shades of green). Although, currently there has been no clear correlation identified between the tendency to leak and the grade of green, we believe that narrow band imaging has a potential role as an aide to the intraoperative colonoscopic evaluation of the colorectal anastomosis.
Conclusion: NBI may play an important role in assessing the vascularity of the bowel. This could have important applications in both assessing as well as predicting the outcomes of intestinal anastomoses. We need larger studies to further categorize and validate these findings.
Program Number: P158