ABSORPTION OF GLYCINE IRRIGATING SOLUTION DURING ENDOSCOPIC TRANSANALRESECTION OF RECTAL TUMORS

PURPOSE: This study was undertaken to evaluate the potential metabolic complications of 1.5 percent glycine irrigating solution during endos copic transanal resection (ETAR) of rectal tumors. METHODS: Thirteen c onsecutive frail patients (mean age, 81 (range, 57-91) years) undergoi ng 18 ETAR were prospectively studied from July 1993 to January 1995. Indications for ETAR included palliation of advanced rectal cancer (12 patients) and an extensive villous tumor (1 patient). A 27-French two -way Iglesias resectoscope was used. Packed cell volume, blood glucose , and serum concentrations of sodium, potassium, and creatinine were m easured before, during (at 45 minutes), and after (at 6 and 24 hours) ETAR. Plasma concentration of glycine and hemoglobin levels were both measured preoperatively and at 45 minutes and 24 hours, respectively. Variables studied included resection time, volume and rate of irrigati ng fluid, height of irrigating fluid bag above operating table, resect ate weight, occurrence of intraperitoneal and extraperitoneal perforat ion, blood loss, and clinical symptoms. RESULTS: Two patients were exc luded. Mean operating time was 456 minutes. A mean of 192.3 liters of irrigant was infused into the rectum. Mean irrigation rate was 43,330 ml/minutes. Mean height of irrigating fluid bag was 692 cm. Extraperit oneal perforation occurred in two patients. Blood loss exceeded 200 ml in four patients, one of whom complained of nausea (operating time, 1 10 minutes). Mean rise in p-glycine at 45 minutes (10,028 mol/l; 387 p ercent of preoperative values) was significant (P = 0.006). Changes in packed cell volume, b-hemoglobin, b-glucose, s-sodium, and s-creatini ne levels were not significant. There was significant correlation betw een p-glycine and s-creatinine levels at six hours (P = 0.033), betwee n p-glycine levels and fall in s-sodium at 24 hours (P = 0.037), and b etween levels of b-hemoglobin and packed cell volume at 24 hours (P = 0.0004). There was a positive linear correlation between p-glycine and operating time (r = 0.7; P = 0.0026) and between p-glycine and volume of irrigating fluid (r = 0.5; P = 0.0386). CONCLUSIONS: Operating tim e best predicts increase of p-glycine in ETAR.