IMPAIRED HEALING OF CERVICAL OESOPHAGOGASTROSTOMIES CAN BE PREDICTED BY ESTIMATION OF GASTRIC SEROSAL BLOOD PERFUSION BY LASER-DOPPLER FLOWMETRY

Objective: To assess the value of relative blood perfusion of the gast ric tube in prediction of impaired healing of cervical oesophagogastro stomies. Design: Prospective study. Setting: University hospital, The Netherlands. Subjects: Thirty patients undergoing transhiatal oesophag ectomy and partial gastrectomy for cancer of the oesophagus or oesopha gogastric junction, with gastric tube reconstruction and cervical oeso phagogastrostomy. Main outcome measures: Operative measurement of gast ric blood perfusion at four sites by laser Doppler flowmetry and perfu sion of the same sites after construction of the gastric tube expresse d as a percentage of preconstruction values. Results: The relative per fusion at the most proximal site of the gastric tube was significantly lower than at the more distal sites (p = 0.001). Nine of 18 patients (50%) in whom the perfusion of the proximal gastric tube was less than 70% of preconstruction values developed an anastomotic stricture, com pared with only 1 of 12 patients (8%) with a relative perfusion of 70% or more (p = 0.024). A reduction in perfusion of the gastric tube did not predict leakage. Conclusion: Impaired anastomotic healing is unli kely if relative perfusion is 70% or more of preconstruction values. P erfusion of less than 70% partly predicts the occurrence of anastomoti c stricture, but leakage cannot be predicted. Factors other than blood perfusion may have a role in the process of anastomotic healing.