Changes in gastric perfusion during oesophagectomy using real time laser doppler imaging may predict patients at risk of anastomotic complications

Background: Anastomotic complications resulting from inadequate perfusion of a gastric conduit have significant implications for patient undergoing esophagectomy. The primary aim of this study was to assess the feasibility and reliability of real time laser doppler imaging (LDI) to measure changes in gastric perfusion during oesophagectomy. The secondary aim was to assess whether there were differences in perfusion between patients with and without anastomotic complications. Methods: Using real time LDI, regional changes in perfusion were measured during construction of a gastric conduit in 20 patients undergoing oesophagectomy (14 male, 6 female, mean age 67, range 47–77 years). Results: There was a significant fall in perfusion for the whole stomach from 93.7% to 69.9% (P<0.001) during formation of the gastric conduit within the abdomen. There were marked regional differences within the stomach with the most significant reduction in perfusion at the fundus/tip of the conduit (54.4%), although perfusion fell significantly at all regions. Of note there was a stepwise degradation in perfusion as each named artery (or major branches thereof) was ligated. There was a further significant fall in perfusion at the fundus of 10.2% to 44.2% (P<0.001) after pull through of the conduit into the thorax or neck. There was a significant difference in perfusion at the tip of the gastric conduit in those patients suffering an anastomotic complication (Leak or stricture) compared to those without (28.5% vs. 52.6%, P<0.001). Perfusion was significantly lower in those patients who developed an anastomotic leak (25.0% vs. 49.0%, P<0.01) and the gradient of this fall was steeper after ligation of the left gastric artery when compared to patients without this complication. Conclusions: Real time non-invasive LDI provides valid and reliable measurements of gastric perfusion during oesophagectomy and could help identify patients at risk of anastomotic complications.