Intraoperative Doppler assessment of gastric tube perfusion in esophagogastroplasty.
BACKGROUND
Intraoperative Doppler ultrasonography is a non-invasive method with a great potential for the assessment of perfusion in surgery. This study aimed to determine the accuracy of Doppler ultrasonography in the assessment of blood flow on the top of an Akiyama-fashioned stomach tube for esophagus substitution. A secondary point of interest was the real length gained after construction of the gastric tube.


METHODS
The Ivor-Lewis two stage gastro-esophagectomy was performed in 22 patients with carcinoma of the lower third of the esophagus. Vascularization of the gastric tube was assessed in every patient by Doppler sonographies after every separate step of stomach mobilization. Control arteriographies were performed at 4 major steps of mobilization to evaluate the accuracy of Doppler measurements.


RESULTS
Doppler assessment showed a sensitivity of 50 to 95%, specificity of up to 97% and overall accuracy between 95% and 75% during the separate steps of construction of the gastric tube. An approximate length of 4 cm was gained after the final mobilization and tubularization of the stomach.


CONCLUSIONS
Our clinical trial revealed an excellent agreement between the results of Doppler sonography and arteriography. Doppler sonography proved to be a precise technique for the evaluation of stomach perfusion, especially for the needs of tissue viability assessment of the stomach tube in esophageal surgery.
Tsekov
Christo
C
Department of General and Thoracic Surgery, Pirogov Emergency Medicine Institute, Sofia, Bulgaria.
Belyaev
Orlin
O
Tcholakov
Oleg
O
Tcherveniakov
Alexander
A
D000328:Adult; D000368:Aged; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D004946:Esophagostomy; D004947:Esophagus / Q000000981:diagnostic imaging; D005260:Female; D015391:Gastroplasty; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013270:Stomach / Q000098:blood supply / Q000000981:diagnostic imaging; D014463:Ultrasonography