Impaired healing of cervical oesophagogastrostomies can be predicted by estimation of gastric serosal blood perfusion by laser Doppler flowmetry.
OBJECTIVE
To assess the value of relative blood perfusion of the gastric tube in prediction of impaired healing of cervical oesophagogastrostomies.


METHODS
Prospective study.


METHODS
University hospital, The Netherlands.


METHODS
Thirty patients undergoing transhiatal oesophagectomy and partial gastrectomy for cancer of the oesophagus or oesophagogastric junction, with gastric tube reconstruction and cervical oesophagogastrostomy.


METHODS
Operative measurement of gastric blood perfusion at four sites by laser Doppler flowmetry and perfusion of the same sites after construction of the gastric tube expressed as a percentage of preconstruction values.


RESULTS
The relative perfusion at the most proximal site of the gastric tube was significantly lower than at the more distal sites (p = 0.001). Nine of 18 patients (50%) in whom the perfusion of the proximal gastric tube was less than 70% of preconstruction values developed an anastomotic stricture, compared with only 1 of 12 patients (8%) with a relative perfusion of 70% or more (p = 0.024). A reduction in perfusion of the gastric tube did not predict leakage.


CONCLUSIONS
Impaired anastomotic healing is unlikely if relative perfusion is 70% or more of preconstruction values. Perfusion of less than 70% partly predicts the occurrence of anastomotic stricture, but leakage cannot be predicted. Factors other than blood perfusion may have a role in the process of anastomotic healing.
Department of Surgery, University Hospital Utrecht, The Netherlands.
J P
JP
Pierie
P W
PW
De Graaf
H
H
Poen
I
I
Van der Tweel
H
H
Obertop
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D003251:Constriction, Pathologic / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D004946:Esophagostomy / Q000009:adverse effects; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005544:Forecasting; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000098:blood supply*; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D013270:Stomach / Q000098:blood supply / Q000601:surgery*; D013274:Stomach Neoplasms / Q000601:surgery; D014945:Wound Healing