"Intraperitoneal microdialysis- after hemicolectomy and rectal resections as a method for early postoperative complications detection"

Abstract

Background: Intraperitoneal microdialysis and measurements of the lactate/pyruvate ratio had recently been presented as a promising method in detecting intraperitoneal ischemia preceding postoperative complications. Aim: To investigate if the magnitude of the surgical procedure influence the postoperative microdialysis response and define different patterns in several pathological conditions. Patients and methods: During the two first postoperative days after noncomplicated surgery sixteen patients operated on due to cancer recti with anterior resection and primary anastomosis were compared to twelve patients operated due to cancer in the right colon with right sided hemicolectomy. They were investigated regarding intraperitoneal postoperative metabolic response with measurements of lacate/pyruvate ratio, glucose and glycerol, Results: Intraperitoneal lactate/pyruvate ratio was initially about 15 in hemicolectomy patients. After rectal resections it was higher the first 31 hours of the study and started at about 18, both groups showed parallel decreasing values. Glucose levels increased 9-11 hours postoperatively in both groups to levels around 9 mmol/l and were thereafter stable during the study. Intraperitoneal glycerol levels were stable initially, around 100  mol/l, but after 20 hours the levels in the rectal resection group had a tendency to increase. Two patients with postoperative complications and increasing lactate/pyruvate ratio and decreasing glucose presents separately. Conclusions: Different magnitudes of the surgical procedure do not significant affect the metabolic intraperitoneal response measured by microdialysis. Different patterns and trends early in the postoperative period characterize the patient who developing a serious postoperative complication, it is of high importance to have metabolic knowledge and recognize those changes.