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J Thorac Cardiovasc Surg 2001;122:1101-1106
© 2001 The American Association for Thoracic Surgery

General Thoracic Surgery (GTS)

Clinical significance of tissue blood flow during esophagectomy by laser Doppler flowmetry

From the First Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.

Received for publication Dec 14, 2000. Revisions requested Feb 9, 2001; revisions received June 1, 2001. Accepted for publication June 8, 2001. Address for reprints: Yoshifumi Ikeda, MD, First Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan (E-mail: yikeda{at}med.teikyo-u.ac.jp).

Abstract

Objectives: We sought to investigate the effect of tissue blood flow on the incidence of anastomotic leakage during esophagectomy.
Methods: Reconstruction was done with a gastric tube, and all cases involved cervical anastomosis. Tissue blood flow of 43 patients was measured with a laser Doppler flowmeter before emplacement and after anastomosis during surgical intervention. The reconstruction route and tissue blood flow before emplacement and that after anastomosis were analyzed as possible factors influencing anastomotic leakage.
Results: Tissue blood flow after anastomosis with leakage was 9.1 ± 2.0 mL/min per 100 g, and that without leakage was 13.7 ± 2.9 mL/min per 100 g. Tissue blood flow with leakage was significantly lower than that without leakage (P < .01, unpaired t test). Twenty-one patients had tissue blood flow after anastomosis of greater than 13 mL/min per 100 g, and none of them had leakage, whereas 5 patients had blood flow of less than 10 mL/min per 100 g, and all 5 had leakage.
Conclusion: Tissue blood flow can be an important and useful indicator of the presence of current anastomotic leakage. Low tissue blood flow after anastomosis may mediate for appropriate surgical or pharmacologic interventions to detect, localize, and counteract leakage.

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