Perfusion of the gastric conduit during esophagectomy

Summary

In esophageal cancer surgery, perfusion of the gastric conduit is a critical issue. Measurement of gastric intramucosal pH (pH_i) 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. pH_i 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 pH_i (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, pH_i increased (7.24 ± 0.09, P  = 0.002). In contrast to open surgery, a trend towards less reduction in pH_i was seen in thoracoscopic surgery. Patients with anastomotic leaks had lower pH_i 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 pH_i. Patients with low pH_i on the first postoperative day were more prone to have clinically relevant anastomotic leaks.

http://ift.tt/2en2nfK