Intraoperative assessment of bowel viability

Viability of ischemic bowel was assessed in 30 dogs after mesenteric arterial ligation in a 40-cm length of ileum. Viability was evaluated using two gross features, color and peristalsis, and four objective methods including bowel wall surface oximetry (pO2), Doppler ultrasound, quantitative fluorescein fluorimetry, and myoelectric activity measured by a strain gauge probe. Each parameter was measured at 2-cm intervals within the 40-cm ischemic segment before resection and anastomosis was performed. There were seven fatal anastomotic leaks, all due to further bowel necrosis. Survival did not correlate with bowel color, presence of peristalsis, bowel wall pO2 Doppler ultrasound, or the myoelectric parameters. However, fluorescein fluorimetry was predictive of long-term viability. These results suggest that quantitative fluorescein fluorimetry may be a useful adjunct in intraoperative bowel viability assessment.