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Effects of endoluminal vacuum sponge therapy on the perfusion of gastric conduit in a porcine model for esophagectomy

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Title: Effects of endoluminal vacuum sponge therapy on the perfusion of gastric conduit in a porcine model for esophagectomy
Authors: Eleni Amelia Felinska, Alexander Studier-Fischer, Berkin Özdemir, Estelle Willuth, Philipp Anthony Wise, Beat Müller-Stich, Felix Nickel
Source: Surg Endosc
Publisher Information: Springer Science and Business Media LLC, 2024.
Publication Year: 2024
Subject Terms: Gastric conduit, Swine [MeSH], Anastomotic leak, Edema/surgery [MeSH], Esophagectomy, Perfusion, Animals [MeSH], Anastomosis, Surgical/methods [MeSH], Article, Anastomotic Leak/surgery [MeSH], Endoluminal vacuum therapy, Esophagectomy/methods [MeSH], Esophagectomy/adverse effects [MeSH], Esophageal Neoplasms/surgery [MeSH], Ischemia/surgery [MeSH], Perfusion [MeSH], Hyperspectral imaging, Stomach/surgery [MeSH], Esophageal Neoplasms, Swine, Anastomosis, Surgical, Stomach, Anastomotic Leak, 03 medical and health sciences, 0302 clinical medicine, Ischemia, Animals, Edema
Description: Background After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy. Material and methods A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (− 40, − 125, and − 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22). Results Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p p p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with − 200 mmHg but not with − 40 and − 125 mmHg. Conclusions EndoVAC therapy with a pressure of − 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion. Graphical abstract
Document Type: Article
Other literature type
Language: English
ISSN: 1432-2218
0930-2794
DOI: 10.1007/s00464-023-10647-0
Access URL: https://pubmed.ncbi.nlm.nih.gov/38180542
https://repository.publisso.de/resource/frl:6518146
Rights: CC BY
Accession Number: edsair.doi.dedup.....01ab8fe3424aea5d935e5beec56a8e12
Database: OpenAIRE
Description
Abstract:Background After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy. Material and methods A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (− 40, − 125, and − 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22). Results Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p p p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with − 200 mmHg but not with − 40 and − 125 mmHg. Conclusions EndoVAC therapy with a pressure of − 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion. Graphical abstract
ISSN:14322218
09302794
DOI:10.1007/s00464-023-10647-0