The Efficacy of Intraoperative Methylene Blue Enemas To Assess The Integrity Of A Colonic Anastomosis

Stanton Smith; William McGeehin; Robert A Kozol; * David Giles

Disclosures

BMC Surg 

In This Article

Methods

Design

We performed a retrospective review of consecutive colonic anastomoses that were performed by one surgical group that uses the MBE exclusively in a community hospital from January 2001 through December 2004. Basic demographic details were gathered, as well as details of the surgery and its results. We defined an intraoperative leak (IOL) as visualization of methylene blue dye outside of the colon (in the operative field). Postoperative leaks (POL) are defined clinically as a constellation of fever, abdominal pain/peritonitis, and leukocytosis, radiographically, or by the institution of treatment indicating that the patient had a leak (such as the creation of a diverting ostomy). Deaths were reviewed for the possibility of unrecognized POLs. Differences between intraoperative and postoperative leak rates were analyzed. All advanced statistical analysis was carried out with SPSS software, version 12.01 for Windows. The University of Connecticut Health Center and Charlotte-Hungerford Hospital IRBs approved the study.

MBE Technique

The apparatus for the enema includes a 28 French Foley catheter with a 30 mL balloon, tubing, and a 1 liter of normal saline containing 10 mL of 1% methylene blue dye (final concentration of 0.01%). The rectal tube is inserted after anesthesia is induced when resecting the proximal 2/3 of colon and delayed until after anastomosis is completed for the distal 1/3 of the colon and the rectum. The Foley balloon is inflated and gently withdrawn to the internal anal sphincter to prevent leakage around the balloon. The anastomosis is surrounded with clean sponges, the colon is occluded proximally and is allowed to fill as the fluid bag was raised. If a leak was present, it will be visualized as spillage of blue dye. When the surgeon is satisfied with the anastomotic integrity, the fluid bag is lowered to the floor to allow gravity drainage. This procedure could be repeated multiple times as needed. (Figure 1)

Figure 1.

MBE Apparatus and Method. A. Apparatus for methylene blue enema. B. Anastomosis with gauze pads beneath: C. Cross sectional view (pelvis).

Comments

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