Intraoperative oximetry of hollow organs in case of gunshot injuries of the abdomen

Abstract

The aim of the study is to analyze the application of intraoperative oximetry for assessing the viability of hollow organ segments during the implementation of Damage Control Surgery (DCS) in patients with gunshot abdominal injuries. Materials and methods. Intraoperative oximetry of the walls of damaged hollow organs was performed in 76 wounded combatants with penetrating gunshot wounds to the abdomen in phase I of DCS, that allowed to determine the state of microcirculation and the viability of the intestinal wall of the injured and other doubtful areas within a few minutes. In phase III of DCS, intraoperative oximetry was performed to assess the viability of questionable areas of both sutured wounds and intestinal stumps after obstructive resections. Results. The high efficiency of intraoperative oximetry in penetrating gunshot injuries of the abdomen in phase I of DCS tactics has been proven. The oxygenation rate in the SpO2 measurement zone of 95 % and above indicates the viability of intestinal tissue and good conditions for anastomosis formation or wound suturing. The SpO2 level from 89 % to 95 % indicates the questionable viability of the intestinal wall, and below 89 % – the deterioration of microcirculation and a high risk of intestinal wall necrosis development. Repeated intraoperative oximetry in phase III of DCS made it possible to assess the viability of the walls of the small intestine and colon, obstructive stumps of the small intestine and colon, and to optimize surgical tactics with repeated resections of suspicious and non-viable areas of the small intestine and colon. In the main group, the formation of ileo-transverse anastomoses increased by 14.6 % (р = 0.013), and transverso-sigmoanastomoses – by 9.9 % (р = 0.030). This became possible due to the reasoned refusal to form terminal stomas. In the main group, ileostomies were not formed, and in the comparison group they were formed in 5.8 % of the wounded. At the same time, colostomies formation was also reduced by 17.7 % (р = 0.008). The consistent use of intraoperative oximetry in the phase I and III of the DCS tactics made it possible to optimize the surgical tactics, which led to a decrease in complications in the main group by 12.4 % (р = 0.007). Conclusions. Intraoperative oximetry for gunshot injuries of the abdominal cavity is a simple, fast and effective method that allows to determine the state of microcirculation in the wall of the hollow organ (its viability) and optimize the nature of surgical intervention in phase I of DCS tactics. Intraoperative oximetry in phase III of DCS allows to determine the state of microcirculation in the areas of sutured intestinal injuries, intestinal stumps after obstructive resections performed in favor of the formation of inter-intestinal anastomoses and prevent the development of complications.

Keywords

• intraoperative oximetry
• abdominal injuries
• wounds gunshot
• hollow organs
• dcs tactics