Assessment of Anastomotic Viability With Spectroscopic Real-time Oxygen Saturation Measurement in a Porcine Study

Objective Anastomotic leakage (AL) is a severe complication following intestinal procedures. Intra.Ox (TM) by ViOptix Inc (Newark, CA, USA) is a novel, FDA-approved spectroscopic device which enables real-time measurement of mixed tissue oxygen saturation (StO(2)). Using a porcine model, this study explores the correlation between StO(2) measurements and AL formation as well as investigates the applicability of Intra.Ox (TM) in the clinical setting. Methods Eleven female swine were divided into 3 groups to explore AL formation in different ischemic conditions. Group 1: 100% mesenteric-vascular ligation, n = 3; Group 2: 50% ligation, n = 5; Group 3: No mesenteric ligation, n = 3. StO(2) at the anastomotic line was measured before and after vessel ligation and anastomosis. Measurements were taken at 6 distinct locations along afferent and efferent loops. AL was evaluated on postoperative day 5 by re-laparotomy. Results AL rate was 100%, 60% and 0% in groups 1, 2 and 3, respectively. Post-anastomotic StO(2) in group 1 (22.9 +/- 18.5%) and 2 (39.2 +/- 20.1%) were significantly lower than in group 3 (53.1 +/- 8.3%, p<.0001). Post-anastomotic StO(2) readings <= 40% indicated AL potential with 100% sensitivity,+ 80% specificity, positive predictive value of 85.7% and negative predictive value of 100%. Conclusion This study demonstrates the value of Intra.Ox (TM) in assessing local perfusion and indicate the association between low StO(2) and AL by providing accurate, real-time, noninvasive tissue oxygenation measurements at anastomotic sites. Further studies are required to investigate the clinical application of this novel device in intestinal surgery.