Value of Routine Flexible Sigmoidoscopy and Potential Predictive Factors for Colonic Ischemia after Open Ruptured...

Area of Science:

• Vascular Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Colonic ischemia (CI) is a significant complication following ruptured abdominal aortic aneurysm (rAAA) repair, contributing to increased patient morbidity and mortality.
• While flexible sigmoidoscopy can detect CI, its routine utility after rAAA repair remains unproven.

Purpose of the Study:

• To assess the effectiveness of routine flexible sigmoidoscopy in identifying CI post-rAAA repair.
• To identify hemodynamic, biochemical, and clinical predictors of CI development in patients undergoing rAAA surgery.

Main Methods:

• Retrospective analysis of 80 patients undergoing open rAAA repair between 2014 and 2017.
• Data collection included flexible sigmoidoscopy findings, CI incidence, and pre- and perioperative/postoperative hemodynamic, biochemical, and clinical variables.
• Logistic regression analysis was employed to determine the association between CI and potential predictors.

Main Results:

• Flexible sigmoidoscopy was performed in 73.5% of surviving patients.
• Perioperative lowest arterial pH and type of aortic graft (aortobifemoral bypass vs. straight graft) showed significant differences between CI groups.
• Postoperative highest lactate (Day 1) and lowest hemoglobin (Day 2) were significantly different in CI groups. Postoperative lactate and hemoglobin were identified as independent risk factors for CI (OR = 1.91 and OR = 0.44, respectively).

Conclusions:

• Flexible sigmoidoscopy can aid in identifying patients at increased risk of mortality after open rAAA repair.
• Postoperative lactate and hemoglobin levels are independent predictors for the development of colonic ischemia following open rAAA repair.
• Larger studies are recommended to validate these findings.