Scanning laser Doppler flowmetry and intraluminal recirculating gas tonometry in the assessment of gastric and jejunal perfusion during oesophageal resection

Abstract

These new techniques could be employed at operation, appear to overcome the limitations of single-point laser Doppler flowmetry and saline tonometry, and have measured significant changes in gastric perfusion. They may have widespread clinical application.

Intraoperative changes of mucosal pCO 2 during gastric tube formation

“…Using a Clark-type oxygen electrode, a decrease in tissue oxygen tension after gastric tube formation was demonstrated in the anastomotic region [6,7]. Similar results were obtained with the intraoperative measurement of oxygen saturation [17], single-point laser flowmetry [5,8], and laser Doppler scanner, indicating an impaired blood flow [9].…”

“…However, the intraoperative assessment of gastric perfusion does not necessarily help to predict postoperative anastomotic complications, since only a minority of patients with a decreased blood flow in the anastomotic region intraoperatively develop an anastomotic leakage postoperatively [9]. The study of microcirculatory changes associated with the formation of a gastric tube therefore has to focus on a technique which can be used postoperatively in order to detect those patients who develop an anastomotic leakage.…”

“…This reconstruction impairs microcirculation in the region of the gastric fundus, the site of anastomosis to the esophagus [4,5,6,7,8,9]. Esophagogastrostomy is associated with an anastomotic leakage in 10-20% of all patients [10,11].…”

Postoperative recovery of microcirculation after gastric tube formation

“…Comparing the results of continuous tonometry with the published data on laser Doppler flowmetry it is obvious that even small changes in pCO 2 I levels are equivalent to a severe impairment of microcirculation in terms of tissue perfusion [2,4,5,7]. This fact is important for the interpretation and understanding of pCO 2 I changes, as demonstrated for patients with an uncomplicated postoperative course after gastric tube formation.…”

“…This is due to partial devascularisation of the stomach, in particular the ligation of the left gastric artery [1]. The intraoperative reduction of tissue perfusion and tissue oxygenation has been demonstrated in several clinical and animal studies [2][3][4][5][6] and is well accepted as the main cause of anastomotic leakage. However, although almost all patients demonstrate this intraoperative impairment, only a minority develop, postoperatively, a leakage of the oesophagogastrostomy.…”