N. Uribe et al., EVALUATION OF RESIDUAL VASCULARIZATION IN ESOPHAGEAL SUBSTITUTION GASTROPLASTY BY SURFACE OXIMETRY-CAPNOGRAPHY AND PHOTOPLETHYSMOGRAPHY, The European journal of surgery, 161(8), 1995, pp. 569-573
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.