Conduit Vascular Evaluation is Associated with Reduction in Anastomotic Leak After Esophagectomy

Abstract

Background: Anastomotic leak following esophagectomy is associated with significant morbidity and mortality. A major factor determining anastomotic success is an adequate blood supply to the conduit. The aim of this study was to determine the impact of intraoperative evaluation of the conduit's vascular supply on anastomotic failure after esophagectomy.

Methods: We retrospectively analyzed data from 90 consecutive patients undergoing esophagectomy with gastric conduit reconstruction. A change in surgical practice occurred after 60 cases were completed, when we introduced the use of intraoperative indocyanine green fluorescence angiography and Doppler examination to evaluate blood supply and assist in construction of the conduit. The leak rates before and after implementation of conduit vascular evaluation were compared.

Results: After the introduction of intraoperative vascular evaluation of the gastric conduit, we noted a dramatic decrease in the rate of anastomotic leak from 20 % in the first 60 patients to 0 % in the succeeding 30 patients.

Conclusions: Intraoperative vascular evaluation with indocyanine green fluorescence imaging and Doppler examination of the gastric conduit used to assist reconstruction after esophagectomy allows for enhanced construction of the conduit that maximizes blood supply to the anastomosis. This change in practice was associated with a significant reduction in anastomotic leak rate.