Intraoperative Assessment of Perfusion of the Gastric Graft and Correlation With XXXX After Esophagectomy.

@entity1 @entity254 @entity834
OBJECTIVE: The aim of the study was to evaluate laser-assisted fluorescent-dye angiography (LAA) to assess perfusion in the gastric graft and to correlate perfusion with subsequent @entity834 . BACKGROUND: @entity834 are a major source of morbidity after esophagectomy with gastric pull-up (GPU). In large part, they occur as a consequence of poor perfusion in the gastric graft. METHODS: Real-time intraoperative perfusion was assessed using LAA before bringing the graft up through the mediastinum. When there was a transition from rapid and bright to slow and less robust perfusion, this site was marked with a suture. The location of the @entity254 relative to the suture was noted and the outcome of the @entity254 ascertained by retrospective record review. RESULTS: Intraoperative LAA was used to assess graft perfusion in 150 consecutive @entity1 undergoing esophagectomy with planned GPU reconstruction. An esophagogastric @entity254 was performed in 144 @entity1 . A leak was found in 24 @entity1 (16.7%) and were significantly less likely when the @entity254 was placed in an area of good perfusion compared with when the @entity254 was placed in an area of less robust perfusion by LAA (2% vs 45%, P < 0.0001). By multivariate analysis perfusion at the site of the @entity254 was the only significant factor associated with a leak. CONCLUSIONS: Intraoperative real-time assessment of perfusion with LAA correlated with the likelihood of an @entity834 and confirmed the critical relationship between good perfusion and anastomotic healing. The use of LAA may contribute to reduced anastomotic morbidity.
