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Reduction in tissue blood flow in J-shaped pelvic ileal reservoirs
D N Armstrong1, L F Sillin, R Chung
1Department of Surgery, Veterans Administration Medical Center, Syracuse, New York, USA.
Purpose:
This study sought to evaluate tissue blood flow during J-shaped ileal reservoir construction.
Methods:
Using laser Doppler flowmetry, tissue blood flow was measured at various locations in J-shaped ileal reservoirs constructed in 10 dogs before pouch-anal anastomosis. For 12 weeks postoperatively, animals were assessed for clinical complications. In another five dogs, tissue blood flow was measured at various stages of J-pouch construction.
Results:
Tissue blood flow in the reservoir was reduced and was lowest at the "apex" of the "J", the site of clinical stricture in one animal. During reservoir construction, longitudinal enterotomy was associated with the greatest reduction in tissue blood flow. Lowest blood flow in the reservoir was at the site of the intended pouch-anal anastomosis (11.5 +/- 1.6 ml/100 g/min vs. 43.4 +/- 3.4 ml/100 g/min (controls); P < 0.05).
Conclusions:
Operative maneuvers of J-shaped ileal reservoir construction, particularly longitudinal enterotomy, significantly reduce tissue perfusion in the involved bowel segment. Tissue blood flow in the pouch is lowest at the site of intended pouch-anal anastomosis, and this may contribute to development of complications seen clinically.