Intraoperative changes of mucosal pCO(2) during gastric tube formation

The formation of a gastric tube after esophagectomy with ligation of the le ft gastric artery and resection of the lesser curvature is associated with microcirculatory changes, especially in the anastomotic region of the fundu s. This influences the healing of the esophagogastrostomy. The presented pr ospective protocol was designed to assess continuous tonometry as a tool to demonstrate microcirculatory changes during gastric tube formation. in 15 patients with esophageal carcinoma, PCO2 of the gastric mucosa (PCO(2)i) wa s measured intraoperatively during formation of a gastric tube. This was do ne by a nasogastric tube with a silicon balloon connected to a Tonocap reci rculating gas analyser. PCO(2)i measurements were compared for a period of 90 min before and after ligation of the left gastric artery and correlated to the corresponding end expiratory PCO2 (PCO(2)e). In 14 of 15 patients ex amined (93.3%), an increase of PCO(2)i after ligation of the left gastric a rtery was demonstrated. PCO(2)i (mean +/- SD) before ligation of the left g astric artery (87 measurements: 40.6 +/-7.5 mmHg; range, 29-67 mmHg) was si gnificantly lower (P <0.001) compared to the mean PCO(2)i after ligation of the left gastric artery (88 measurements: 49.1 +/- 10.2 mmHg; range, 31-79 mmHg). Continuous tonometry is a valid method to detect changes in mucosal PCO2 during gastric tube formation and should be assessed to monitor the g astric interposition graft during the postoperative course.