Improvement of circulation in pedicled intestinal grafts: hemodynamics of the intestine after preparation of a sacrificial colonic graft.
BACKGROUND
To preserve postoperative digestive function in patients with esophageal carcinoma, jejunal or colonic segments on long vascular pedicles are transplanted and anastomosed between the esophagus and residual stomach. A postoperative survey showed pedicled jejunum transplantation to be superior in terms of digestive and absorptive functions, intraesophageal pressure, pH, and the quality of life of long-term postoperative survivors. Anastomotic leakage and necrosis of the pedicled intestinal graft are occasional complications; circulatory disorders of the pedicled intestine are a probable cause of both complications.


METHODS
To simulate pedicled jejunum transplantation, we prepared pedicled colonic segments from dogs and measured blood flow volume at the cut end of the oral side of the colonic segments using the hydrogen clearance method and at the nutrient vascular pedicle with an electromagnetic blood flowmeter.


RESULTS
Resection of excess colon increased blood flow volume per unit weight of the colonic segment.


CONCLUSIONS
It is essential to resect excess intestine and keep only the minimum length of pedicled intestinal graft needed for reconstruction of the esophagus.
Ashizawa
I
I
Second Department of Surgery, Tohoku University School of Medicine, Sendai, Japan.
Nishihira
T
T
Kasai
M
M
D000714:Anastomosis, Surgical; D000818:Animals; D003106:Colon / Q000098:blood supply* / Q000502:physiology / Q000637:transplantation*; D004285:Dogs; D006439:Hemodynamics; D012039:Regional Blood Flow; D012212:Rheology; D013524:Surgical Flaps / Q000379:methods / Q000502:physiology*