Document Detail


Intraoperative scanning laser Doppler flowmetry in the assessment of gastric tube perfusion during esophageal resection.
MedLine Citation:
PMID:  10235577     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ischemia from tissue hypoperfusion in the gastric tube after esophagectomy is believed to contribute significantly to postoperative complications associated with anastomotic failure. This study assessed the ability of the new technique of laser Doppler flowmetry to measure differential levels of blood flow in human gastric tubes during esophagectomy. STUDY DESIGN: Gastric perfusion was measured in 16 patients undergoing esophagectomy by making laser Doppler scans of the stomach before mobilization and after formation of the gastric tube. Mean perfusion was calculated within the whole anterior surface of the stomach or tube and within 1 cm2 regions of interest, each of which contained 1,750 individual measurements of perfusion. These regions represented the cephalic end of the gastric tube, 10 adjacent 1 cm2 regions distally along the tube, and the proposed anastomosis site. Results were expressed as mean perfusion units, and tissue blood flow from each scan in each region was compared. RESULTS: There were significant decreases in gastric perfusion measured with the scanning laser Doppler in all patients after formation of the gastric tube. Mean perfusion of the stomach fell 41% (p<0.0005) after mobilization. In all patients there was a gradient of perfusion from the proximal end of the tube where flow was poor, to more distal areas where it was higher. At the proximal end of the tube perfusion fell by a mean of 72%, 5 cm distally the mean fall was 44%, and 10 cm from the proximal end of the tube the mean fall was 28%. At the anastomosis site mean perfusion fell 55%. CONCLUSIONS: This new technique can be used intraoperatively and appears to overcome the limitations of single point laser Doppler flowmetry. It has measured large differences in perfusion at different sites within the gastric tubes and could therefore have widespread clinical applications.
Authors:
N H Boyle; A Pearce; D Hunter; W J Owen; R C Mason
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  188     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  1999 May 
Date Detail:
Created Date:  1999-05-20     Completed Date:  1999-05-20     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  498-502     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Guy's and St Thomas's Hospitals, London, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anastomosis, Surgical / adverse effects
Esophagectomy* / adverse effects
Female
Humans
Intraoperative Complications / diagnosis
Intraoperative Period
Ischemia / diagnosis,  etiology
Laser-Doppler Flowmetry*
Male
Middle Aged
Regional Blood Flow
Stomach / blood supply*,  surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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