Blood gas analysis of the jejunum in the supercharge technique: to what degree does circulation improve?
BACKGROUND
The supercharge technique has become widely prevalent in the field of esophageal reconstruction. Despite the logical advantages with this technique, the actual degree of its effect on the blood circulation is not clear. There may be cases in which the supercharge technique is not necessary for survival of the jejunum. To decide whether or not the supercharge technique is indicated, it is crucial to know how effective it is in improving blood flow to the jejunum.


METHODS
The effect of the additional vessel anastomosis in the pedicled jejunal transfer was evaluated by blood gas analysis of the venous blood in the mesenteric vein. In 27 patients undergoing pedicled jejunal transfer with additional vessel anastomosis using the internal mammary vessels for reconstruction of the thoracic esophagus, intraoperative blood sampling was performed three times: before anastomosis, after venous anastomosis, and after venous and arterial anastomosis.


RESULTS
The venous partial pressure of oxygen showed little increase after the venous anastomosis (mean, 115.7 percent; p = 0.0022). In contrast, venous partial pressure of oxygen increased markedly after the arterial and venous anastomosis in most of the patients (mean, 177.8 percent; p < 0.0001). Similarly, venous partial pressure of carbon dioxide, after both anastomoses, decreased to a lower level than before the additional anastomosis in most patients (mean, 93.1 percent; p = 0.035).


CONCLUSIONS
The authors conclude that the additional anastomosis of both the artery and the vein is recommended if it is possible.
Ueda
Kazuki
K
Fukushima, Tokyo, and Shizuoka, Japan From the Departments of Plastic and Reconstructive Surgery, Fukushima Medical University and University of Tokyo, and Department of Plastic Surgery, Shizuoka Cancer Center.
Kajikawa
Akiyoshi
A
Suzuki
Yasutoshi
Y
Okazaki
Mutsumi
M
Nakagawa
Masahiro
M
Iida
Shoko
S
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D000714:Anastomosis, Surgical / Q000379:methods; D001784:Blood Gas Analysis; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007583:Jejunum / Q000098:blood supply* / Q000637:transplantation*; D008297:Male; D008638:Mesenteric Arteries / Q000378:metabolism / Q000601:surgery; D008642:Mesenteric Veins / Q000378:metabolism / Q000601:surgery; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010101:Oxygen Consumption / Q000502:physiology; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods