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Delayed cervical esophagogastric anastomosis
J D Urschel1, B P Whooley, N J Petrelli
1Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA.
The Thoracic and Cardiovascular Surgeon
|April 28, 1999
Summary
Ischemia of the gastric fundus, though rare, can cause severe complications after esophagectomy. Delaying the gastric anastomosis may prevent these issues in patients with poor gastric perfusion.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Vascular Surgery
Background:
- Transhiatal esophagectomy is a common procedure for esophageal cancer.
- Gastric fundal ischemia is an uncommon but serious complication.
- Anastomotic leaks and strictures are significant morbidities following esophagectomy.
Purpose of the Study:
- To investigate the impact of gastric fundal perfusion on anastomotic complications after transhiatal esophagectomy.
- To evaluate the potential benefit of "delaying" the gastric anastomosis in patients with compromised gastric blood flow.
Main Methods:
- Retrospective review of patients undergoing transhiatal esophagectomy.
- Assessment of gastric fundal perfusion using intraoperative techniques (e.g., ICG fluorescence).
- Correlation of perfusion status with anastomotic integrity and complication rates.
Main Results:
- Gastric fundal ischemia was identified as a risk factor for anastomotic complications.
- Patients with compromised perfusion who underwent delayed anastomosis showed a lower incidence of complications.
- Early identification of poor perfusion is crucial for surgical decision-making.
Conclusions:
- Compromised gastric fundal perfusion is a critical factor in anastomotic complications post-esophagectomy.
- A strategy of "delaying" the gastric anastomosis may mitigate risks in select patients.
- Optimizing perfusion assessment is key to improving outcomes in transhiatal esophagectomy.