260. EFFECT OF ENDOLUMINAL VACUUM THERAPY ON THE PERFUSION OF GASTRIC CONDUIT IN A PORCINE MODEL FOR ESOPHAGECTOMY

Abstract

Abstract After esophagectomy, the postoperative rate of anastomotic leakage is between 5 and 30% and is the main driver of morbidity and mortality. Complication management is often based on endoluminal vacuum therapy (EndoVAC) with good success rates. Vacuum therapy has been shown to improve tissue perfusion in superficial wounds but this has not been shown for gastric conduits. The present study aimed to assess changes in gastric conduit perfusion in a porcine model for esophagectomy. Porcine model (n = 18) underwent gastric conduit formation and induction of partial conduit ischemia. In three experimental groups EndoVAC therapy was used in the gastric conduit (−40 mmHg, −125 mmHg and − 200 mmHg) with continuous suction. The changes in tissue perfusion and edema were assessed using hyperspectral imaging (HSI). During EndoVAC treatment with −125 mmHg a significant and stable increase in the oxygenation index from 44.9 ± 7.6% to 61.9 ± 5.5% and 62.9 ± 9.4%. (p = 0.02) was seen after 60 minutes and 120 minutes respectively. A similar trend was seen during EndoVAC treatment with −200 mmHg. There was a non-significant increase in tissue oxygenation during treatment with −40 mmHg. A significant increase of tissue water content from 40.8 ± 7.4 to 59.5 ± 10.3 (p = 0.004) was observed after 60 minutes of EndoVAC therapy with −200 mmHg. There were no significant differences in tissue water content during EndoVAC therapy with −40 mmHg and − 125 mmHg. EndoVAC treatment with a pressure of at least −125 mmHg significantly increases perfusion of partial ischemic gastric conduit. With better understanding of underlying physiology, the optimal use of EndoVac treatment can be guided and determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion. This can potentially be translated into clinical practice.