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Perfusion of the ga...
Perfusion of the gastric conduit during esophagectomy
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- Linder, Gustav (författare)
- Uppsala universitet,Gastrointestinalkirurgi
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- Hedberg, Jakob, 1972- (författare)
- Uppsala universitet,Gastrointestinalkirurgi
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- Björck, Martin (författare)
- Uppsala universitet,Kärlkirurgi
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- Sundbom, Magnus (författare)
- Uppsala universitet,Gastrointestinalkirurgi
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(creator_code:org_t)
- 2016-10-21
- 2017
- Engelska.
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Ingår i: Diseases of the esophagus. - : Oxford University Press (OUP). - 1120-8694 .- 1442-2050. ; 30:1, s. 143-149
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- In esophageal cancer surgery, perfusion of the gastric conduit is a critical issue. Measurement of gastric intramucosal pH (pHi ) is a method to identify anaerobic metabolism as a sign of impaired perfusion. In this study we aimed to monitor changes in the perfusion of the gastric conduit at key steps during and after esophagectomy. pHi was measured per- and postoperatively using intermittent gastric tonometry in 32 patients undergoing open, 65%, or video-assisted thoracoscopic esophagectomy for esophageal cancer. Measurements focused on the surgical steps when the vascular supply to the gastric conduit was altered. A tonometry catheter was successfully placed in all patients and a decrease in pHi (mean ± SD) was observed from baseline to after the division of the short gastric vessels (7.33 ± 0.07 to 7.29 ± 0.07, P = 0.005). A further reduction after the ligation of the left gastric artery (7.26 ± 0.08, P < 0.001) and after final linear stapling the gastric conduit (7.15 ± 0.13, P < 0.001) was observed. Two hours after surgery, pHi increased (7.24 ± 0.09, P = 0.002). In contrast to open surgery, a trend towards less reduction in pHi was seen in thoracoscopic surgery. Patients with anastomotic leaks had lower pHi on the first postoperative day (7.12 ± 0.05 vs. 7.27 ± 0.08, P = 0.040). It can be concluded that each surgical step altering the vascular supply to the gastric conduit resulted in detectable changes, however transient, in pHi . Patients with low pHi on the first postoperative day were more prone to have clinically relevant anastomotic leaks.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Gastroenterologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Gastroenterology and Hepatology (hsv//eng)
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