RA05.03: THE INFLUENCE OF ANASTOMOSIS ON THE BLOOD SUPPLY OF STOMACH AND THE OPTIMIZATION OF WIDTH OF TUBULAR STOMACH IN END-TO-SIDE ESOPHAGEAL-GASTRIC ANASTOMOSIS

Abstract

Abstract Background End-to-side esophageal-gastric anastomosis is the most commonly used method of anastomosis in esophagectomy. Narrow gastric tube, especially 3cm-wide one, is thought to improve the blood supply of stomach. But with the combine use of these two techniques, we found alimentary tract leakage became more common. The reason was obscure. Few have considered the influence of anastomosis-induced gastric wall defect on the blood supply of gastric tube (Figure 1). We carried out this research to prove this hypothesis and to find out method to resolve this problem. Methods Animal experiment and clinical cohort study have been carried out. Narrow gastric tube group (3cm wide) and baseball-bat-shaped gastric tube group (5cm in avascular area) were compared. In animal experiment, 3 pigs in each group. Impaired blood supply will slow down blood flow and cause metabolic acidosis. So blood gas analysis (with the blood collected in gastric wall distal or proximal to the anastomosis) and arteriography with methylene blue were performed. pH and BE(from blood gas analysis) and time required for methylene blue to reach the tip of gastric tube were used to evaluate the blood supply of these areas. In cohort study, 176 patients were enrolled with 24 in narrow gastric tube group and 152 in bat-like gastric tube group. The incidence of leakage was compared. Results In animal experiment, before anastomosis, no metabolic acidosis was found in both groups. But after anastomosis, methylene blue couldn’t reach the gastric wall distal to the anastomosis, and the blood gas analysis shows metabolic acidosis with the blood from the same area, only in narrow group, These indicated insufficient blood supply in this area. In the cohort study, the incidence of leakage was much higher in narrow group. Conclusion Anastomosis can influence the blood supply of the gastric tube distal to it. It's the reason of the increase of alimentary tract fistula incidence with the use of 3cm-wide narrow gastric tube. Widen the gastric avascular area is an effective way to prevent this. So for end-to-side anastomosis, 5cm-wide gastric tube is preferred, while narrower gastric tube is suitable for other mode of anastomosis which do not cause gastric wall defect Disclosure All authors have declared no conflicts of interest.