Perfusion of the gastric conduit during esophagectomy

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Linder, GustavUppsala universitet,Gastrointestinalkirurgi (author)

Perfusion of the gastric conduit during esophagectomy

Article/chapterEnglish2017

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2016-10-21
Oxford University Press (OUP),2017
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LIBRIS-ID:oai:DiVA.org:uu-308550
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-308550URI
https://doi.org/10.1111/dote.12537DOI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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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.

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Hedberg, Jakob,1972-Uppsala universitet,Gastrointestinalkirurgi(Swepub:uu)jakhe890 (author)
Björck, MartinUppsala universitet,Kärlkirurgi(Swepub:uu)mabjo425 (author)
Sundbom, MagnusUppsala universitet,Gastrointestinalkirurgi(Swepub:uu)magsundb (author)
Uppsala universitetGastrointestinalkirurgi (creator_code:org_t)

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In:Diseases of the esophagus: Oxford University Press (OUP)30:1, s. 143-1491120-86941442-2050

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Gastroenterology ...

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