Abstract:Purpose: To evaluate hyperbaric oxygen therapy (HBO) after esophagojejunal anastomosis in a rat experimental model and the effect of HBO on the healing of esophagojejunal anastomosis in gastrectomized rats. Methods: Forty adult male Wistar rats, weighing 322 g to 506 g, were divided into two random groups. In group A (control group), 20 rats were subjected to total gastrectomy. In group B, 20 rats were similarly gastrectomized, but also received postoperative HBO treatment for 90 minutes/day for seven days. Al… Show more
“…HBOT after the procedure or when the lesion is already in place is a well-established tool in clinical practice; the most commonly studied approach to date is postoperative HBOT [4][5][6][7][8] . Benefits of HBOT preceding the intervention have also been reported, in surgery 9 , in radiotherapy 10,11 , and in procedures related to experimentally induced neurological lesions in animal models 5,12 .…”
Conception and design of the study, technical procedures, acquisition and interpretation of data, statistics analysis, manuscript preparation and writing, critical revision, final approval.
“…HBOT after the procedure or when the lesion is already in place is a well-established tool in clinical practice; the most commonly studied approach to date is postoperative HBOT [4][5][6][7][8] . Benefits of HBOT preceding the intervention have also been reported, in surgery 9 , in radiotherapy 10,11 , and in procedures related to experimentally induced neurological lesions in animal models 5,12 .…”
Conception and design of the study, technical procedures, acquisition and interpretation of data, statistics analysis, manuscript preparation and writing, critical revision, final approval.
OBJECTIVES
Failure of anastomotic healing is a morbid complication after airway or oesophageal surgery. Hyperbaric oxygen therapy (HBOT) has been used extensively in the management of complex wound-healing problems. We demonstrate the use of HBOT to rescue at-risk anastomoses or manage anastomotic failures in thoracic surgery.
METHODS
Retrospective review of 25 patients who received HBOT as part of the management of tracheal or oesophageal anastomotic problems during 2007–2018. HBOT was delivered at 2 atm with 100% oxygen in 90-min sessions.
RESULTS
Twenty-three patients underwent airway resection and reconstruction while 2 patients underwent oesophagectomy. There were 16 (70%) laryngotracheal and 7 (30%) tracheal resections. Necrosis at the airway anastomosis was found in 13 (57%) patients, partial dehiscence in 2 (9%) patients and both in 6 (26%) patients. HBOT was prophylactic in 2 (9%) patients. Patients received a median of 9.5 HBOT sessions (interquartile range 5–19 sessions) over a median course of 8 days. The airway anastomosis healed in 20 of 23 (87%) patients. Overall, a satisfactory long-term airway outcome was achieved in 19 (83%) patients; 4 patients failed and required reoperation (2 tracheostomies and 1 T-tube). HBOT was used in 2 patients after oesophagectomy to manage focal necrosis or ischaemia at the anastomosis, with success in 1 patient. Complications from HBOT were infrequent and mild (e.g. ear discomfort).
CONCLUSIONS
HBOT should be considered as an adjunct in the management of anastomotic problems after airway surgery. It may also play a role after oesophagectomy. Possible mechanisms of action are rapid granulation, early re-epithelialization and angiogenesis.
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