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World Journal of Surgery

, Volume 38, Issue 1, pp 138–143 | Cite as

Hemodynamics of the Reconstructed Gastric Tube During Esophagectomy: Assessment of Outcomes with Indocyanine Green Fluorescence

  • Youichi Kumagai
  • Toru Ishiguro
  • Norihiro Haga
  • Koki Kuwabara
  • Tatsuyuki Kawano
  • Hideyuki Ishida
Article

Abstract

Background

Construction of a gastric tube that is well perfused with blood during esophagectomy is the most important factor in avoiding anastomotic leakage. We clarified the hemodynamics of the reconstructed gastric tube with indocyanine green (ICG) fluorescence.

Methods

In 20 patients undergoing gastric tube reconstruction during esophagectomy, we evaluated blood flow in the gastric tube with ICG fluorescence imaging. We divided the patients into two groups according to the quality of blood flow to the gastric tube—“good” (n = 9) and “sparse or absent” (n = 11)—based on visual assessment of the anastomosis of the right and left gastroepiploic vessels. We measured the time from initial enhancement of the root of the right gastroepiploic artery until enhancement of the most cranial branch of the left gastroepiploic artery and tip of the gastric tube.

Results

The gastric tube was divisible into three zones according to the dominant arteries present in the greater curvature under ICG fluorescence. The left gastroepiploic artery was enhanced in a direction opposite that of physiological blood flow in all cases. The median period from initial enhancement of the root of the right gastroepiploic artery to the most cranial branch of the left gastroepiploic artery until perfusion up to the tip of the gastric tube did not differ significantly between the “good” and the “sparse or absent” groups (P = 0.24, 0.68)

Conclusions

It is essential to preserve the whole vessel arcade of the greater curvature to achieve good blood perfusion in the gastric tube. The ICG fluorescence method has potential usefulness for evaluation of blood flow in the gastric tube.

Keywords

Anastomotic Leakage Gastric Tube Gastric Wall Short Gastric Vessel Gastroepiploic Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

This study was supported by a grant from Saitama Medical Center, Saitama Medical University.

Conflict of interest

The authors declare no conflicts of interest.

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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Youichi Kumagai
    • 1
  • Toru Ishiguro
    • 1
  • Norihiro Haga
    • 1
  • Koki Kuwabara
    • 1
  • Tatsuyuki Kawano
    • 2
  • Hideyuki Ishida
    • 1
  1. 1.Department of Digestive Tract and General Surgery, Saitama Medical CenterSaitama Medical UniversityKawagoeJapan
  2. 2.Department of SurgeryTokyo Medical and Dental UniversityTokyoJapan

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