Surface Microdialysis Detects Ischemia After Esophageal Resection—An Experimental Animal Study

• Published in: The Journal of surgical research Vol. 245; pp. 537 - 543
• Main Authors: Åkesson, Oscar, Falkenback, Dan, Johansson, Göran, Abrahamsson, Pernilla
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Anastomosis, Surgical - adverse effects; Anastomotic Leak - diagnosis; Animals; Clinical Medicine; Disease Models, Animal; Esophagectomy - adverse effects; Esophagus - blood supply; Esophagus - pathology; Esophagus - surgery; Gastroenterologi; Gastroenterology and Hepatology; Humans; Ischemia; Ischemia - diagnosis; Ischemia - etiology; Ischemia - pathology; Kirurgi; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Metabolism; Microdialysis; Microdialysis - methods; Oxygen - analysis; Severity of Illness Index; Surgery; Sus scrofa; Ischemia; Metabolism; Microdialysis
• ISSN: 0022-4804; 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2019.07.060

After an esophageal resection, continuity is commonly restored by a gastric tube reconstruction and an intrathoracic anastomosis to the remaining proximal esophagus. Ischemia of the anastomotic region is considered to play a pivotal role in anastomotic leakage. Microdialysis (μD) is an excellent method to measure local biochemical substances and parameters in a specific organ or compartment aiming at early detection of ischemia. This animal study evaluates ischemia of the gastric tube reconstruction using a novel method—μD on organ surfaces. This promising method may have the potential to detect an anastomotic leakage before clinical symptoms develop. Anesthetized normoventilated pigs were used. Surface microdialysis (S-μD) catheters and an intraparenchymal oxygen tension catheter were placed on the stomach. A gastric tube was made and the gastroepiploic artery was divided halfway along the greater curvature to produce severe ischemia at the top of the gastric tube. μD data from four locations (gastric tube, ileum and peritoneal cavity) were recorded every 20 min during the experiment. Tissue samples from all catheter sites underwent histopathological analysis. Intraparenchymal oxygen partial pressure, systemic blood tests, and hemodynamic parameters were recorded. S-μD data showed values indicating severe ischemia at the top of the gastric tube and intermediate ischemia at the level of transection of the gastroepiploic artery. Ischemia was verified by histopathological analysis of tissue samples and intraparenchymal oxygen tension data. S-μD can detect and grade severity of local ischemia in real time, in an animal model.