Postoperative recovery of microcirculation after gastric tube formation

The formation of a gastric tube is associated with partial devascularisation of the stomach and impaired tissue perfusion in the anastomotic region. The aim of the study was to gain data on the time interval of microcirculatory recovery of the normal gastric conduit.

Twenty-nine out of 49 consecutive patients who had undergone oesophagectomy and reconstruction with a gastric tube and intrathoracic oesophagogastrostomy were selected. Inclusion criterion was an uncomplicated postoperative course. After the patients' admission to ICU, continuous measurement of mucosal pCO(2) (pCO(2)I) was commenced, with the use of recirculating gas analysis with a TONOCAP device. pCO(2)I values (in mmHg and kPa) were recorded hourly and related to the arterial pCO(2) (DeltapCO(2) = pCO(2)I - pCO(2)a). In addition, mean arterial pressure (MAP), cardiac output (CO) and systemic vascular resistance (SVR) were measured by pulse contour analysis.

pCO(2)I was monitored over an average period of 79 h (total 2,288 measurements). The mean DeltapCO(2) before extubation was 12.4 mmHg (1.7 kPa) +/- 8.7 SD (1.2 kPa). After extubation, there was an increase in DeltapCO(2) values in all 29 patients. The peak DeltapCO(2) of 27.4 mmHg (3.7 kPa) +/- 12.6 SD (1.7 kPa) was observed 18 h after extubation. This was followed by a steady decline in DeltapCO(2) values that almost reached baseline DeltapCO(2) values after 4 days of monitoring. Changes in DeltapCO(2) did not correlate with changes in MAP, CO and SVR.

High levels of pCO(2)I indicate an impaired postoperative microcirculation in normal gastric tubes. After initial deterioration, gastric microcirculation takes approximately 4 days to recovery. These data are important for the implementation of ischaemic conditioning prior to gastric tube formation and gastric pull-up.