Updates in Surgery

, Volume 68, Issue 2, pp 185–190 | Cite as

Intra-operative hypotensive episodes may be associated with post-operative esophageal anastomotic leak

  • Uberto FumagalliEmail author
  • Alessandra Melis
  • Jana Balazova
  • Valeria Lascari
  • Emanuela Morenghi
  • Riccardo Rosati
Original Article


This study aims to report the hypotensive episodes (HEs) during esophagectomy and their influence on the occurrence of anastomotic leak. Eighty-four patients underwent esophagectomy with gastric pull-up. Pre-, intra-, and post-operative data were prospectively collected. HEs were defined by systolic pressure decreasing more than 30 % of the basal value for more than 5 min. Nineteen patients had intra-operative HEs (22.6 %). HEs were significantly more frequent in patients undergoing prone esophagectomy (P = 0.001) and those with an epidural catheter (EC) (P = 0.04) used during surgery. Among them, 15 were treated with vasopressors. There were six severe post-operative anastomotic leaks, which required surgery; leaks were significantly more common in patients with intra-operative HEs (21 vs 3.1 %; P = 0.02), especially those treated with vasopressive agents (20 vs 0 %; P = 0.008). Intra-operative use of EC can, in certain conditions, significantly influence gastric blood flow due to HEs. A higher incidence of severe leak occurred in patients experiencing intra-operative HEs. Several factors can lead to intra-operative HEs, and the perioperative use of an EC should be carefully evaluated.


Esophagectomy Thoracic epidural analgesia Anastomotic leak Intra-operative fluid management Anastomotic healing Hypothension 



The study and publication were not funded by any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

All the authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research involving human participants and/or animals

This article does not contain any "studies" with human participants or animals performed by any of the authors; all the clinical procedures analyzed in the present paper represent standard clinical care.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Surgery (SIC) 2016

Authors and Affiliations

  • Uberto Fumagalli
    • 1
    • 5
    Email author
  • Alessandra Melis
    • 1
  • Jana Balazova
    • 2
  • Valeria Lascari
    • 2
  • Emanuela Morenghi
    • 3
  • Riccardo Rosati
    • 1
    • 4
  1. 1.General and Minimally Invasive SurgeryHumanitas Clinical and Research HospitalRozzanoItaly
  2. 2.Anesthesiology and Critical CareHumanitas Clinical and Research HospitalRozzanoItaly
  3. 3.Biostatistic UnitHumanitas Clinical and Research HospitalRozzanoItaly
  4. 4.Digestive SurgeryUniversity Vita e SaluteMilanItaly
  5. 5.Esophagogastric SurgeryHumanitas Clinical and Research HospitalRozzanoItaly

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