• Surgical innovation · Oct 2015

    Metabolism-Guided Bowel Resection: Potential Role and Accuracy of Instant Capillary Lactates to Identify the Optimal Resection Site.

    • Michele Diana, Eric Noll, Pierre Diemunsch, François-Marie Moussallieh, Izzie-Jacques Namer, Anne-Laure Charles, Véronique Lindner, Vincent Agnus, Bernard Geny, and Jacques Marescaux.
    • IRCAD Institute for Research Against Cancer of the Digestive System, Strasbourg, France IHU-Strasbourg, University Institute for Image-Guided Surgery, Strasbourg, France University of Strasbourg, Strasbourg, France michele.diana@ircad.fr.
    • Surg Innov. 2015 Oct 1; 22 (5): 453-61.

    BackgroundStrip-based handheld devices can measure lactatemia on capillary blood obtained by needle puncturing. We aimed to assess the kinetic of bowel capillary lactates, metabolomics profiling, and mitochondria respiratory rate in a prolonged model of bowel hypoperfusion.Materials And MethodsIn 6 pigs, a 3- to 4-cm ischemic segment was created in 6 small bowel loops (total = 36 loops) by clamping the vascular supply, for a duration of 1 to 6 hours. Hourly, 5 blood samples were obtained by puncturing the serosa, and lactates were measured using a handheld analyzer. Samples were made at the following regions of interest (ROIs): center of the ischemic area (1), proximal and distal clinical margins of resection (2a-2b), and vascularized zones (3a-3b). Every hour, surgical biopsies of ROIs were sampled. Activity of bowel mitochondria complexes was measured after 1, 3, and 5 hours of ischemia. Quantification of metabolites was performed on all samples (total N = 180).ResultsCapillary lactates were significantly higher at ROI 1 versus ROI 3ab at all time points. After 1 hour lactates at the margins were significantly higher than those at vascularized areas (P = .0095), showing a mismatch between visual assessment and actual perfusion status. From 2 to 6 hours, there was no difference in lactates between ROIs 2a-2b and 3a-3b. Maximal tissue respiration decreased significantly after 1 hour (ROI 1 vs ROI 3ab). Seven metabolites (lactate, glucose, aspartate, choline, creatine, taurine, and tyrosine) expressed significantly different evolutions between ROIs.ConclusionsCapillary lactates could help precisely estimate local bowel perfusion status.© The Author(s) 2015.

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