Perioperative assessment of the intestinal viability

Abstract

The assessment of a intestinal segment’s viability and its degree of ischemia only by clinical criteria is often hard for the surgeon. Sometimes it’s necessary to use auxiliary methods to assess the degree of intestinal injury, which sometimes is imperceptible by clinical evaluation. This review presents the principal methods to undergo this evaluation, describing their technique and necessary equipament, as long as their results. The analized methods were divided in experimental: eletromiography, non-contact tissue laser Doppler and thermal imaging; and clinical: clinical criteria, Doppler
ultrasonography, laser Doppler, intravascular dyes, surface oximetry, pulse oxymetry, thermography, pH measurement, tonometry and infrared photopletysmography. The results of second-look laparotomies in patients with mesenteric vascular insufficiency who were operated are described too. After reviewing all the literature, we found that Doppler ultrasound and fluorescein injection are, due to its costs and easy
menagement, the most used and accepted methods to assess the perioperative intestinal viability. We had also observed that post-operative laparoscopy has a high value on the monitorization of the intestinal viability in patients that undergo surgical treatment for mesenteric vascular insufficiency, especially if the introperative assessment of their intestinal viability wasn’t do precise.