EVALUATION OF RESIDUAL VASCULARIZATION IN ESOPHAGEAL SUBSTITUTION GASTROPLASTY BY SURFACE OXIMETRY-CAPNOGRAPHY AND PHOTOPLETHYSMOGRAPHY

Objective. To evaluate residual vascularisation in gastroplasty and it s possible relation to the development of anastomotic fistulas or dehi scences after oesophageal resection. Design: Experimental open study. Material: Eleven mongrel dogs. Interventions: Gastric parietal blood f low was evaluated by photoplethysmography and measurement of surface o xygen and carbon dioxide tensions under basal conditions and after Aki yama's tubular gastroplasty. Temperature, heart rate, and electrocardi ogram; arterial pressure, pulmonary arterial pressure, pulmonary capil lary pressure, central venous pressure, cardiac output, venous oxygen saturation, and arterial blood gas tensions were monitored under stabl e haemodynamic conditions. Results: After gastroplasty, the mean seros al oxygen tension (pO(2)) of 8.6 mmHg and carbon dioxide tension (pCO( 2)) of 99.5 mmHg and residual photoplethysmographic wave amplitude (8% ) indicated considerable severe ischaemia at the fundus. There was rel ative ischaemia of the mid-stomach with residual mean values of 52.7 m mHg, 77.8 mmHg, and 57% for pO(2); pCO(2) and PPG wave amplitude, resp ectively. Conclusions: Important devascularisation of the fundus, theo retically incompatible with healing, occurs after gastroplasty. Operat ive photoplethysmography and surface measurements of pO(2) and pCO(2) are good ways of evaluating the level and degree of ischaemia in gastr ic tubes for oesophageal replacement.