Transient bloodletting of the short gastric vein in the reconstructed gastric tube improves gastric microcirculation during esophagectomy.
The reasons for anastomotic leakage in esophago-gastrostomy have been proposed to be poor arterial inflow and insufficient venous drainage at the anastomotic site. In order to improve the congestive status, we developed a novel and easy surgical procedure of transient bloodletting from the short gastric vein after making a gastric tube during esophagectomy, and evaluated tissue blood flow. Patients with esophageal cancer, who had received transthoracic esophagectomy and gastric tube reconstruction with intrathoracic anastomosis, were enrolled. After making a slender gastric tube, transient bloodletting from the short gastric vein at the most cardiac site was performed for 30 minutes. The tissue blood flow of the proximal end of the gastric tube was measured using a laser Doppler flowmeter, and was compared in the bloodletting group (n = 68) and the control group without bloodletting (n = 8). In the bloodletting group, tissue blood flow 5 minutes after the start of bloodletting was markedly increased in comparison to that before bloodletting (9.5 +/- 4.9 ml/min/100 g vs. 24.1 +/- 5.9 ml/min/100 g). The elevated levels of tissue blood flow remained at almost constant levels after ceasing bloodletting and lasted until esophago-gastrostomy (20.1 +/- 3.9 ml/min/100 g). On the contrary, in the control group without bloodletting, tissue blood flows were marginally increased following construction of a gastric tube, but the changes did not reach significant levels. When the tissue blood flow just before esophago-gastrostomy was compared in the bloodletting and control groups, the flows in the bloodletting group were significantly more elevated than those in the control group (20.1 +/- 3.9 vs. 15.2 +/- 4.9 ml/min/100 g). Transient bloodletting of the short gastric vein in the gastric tube during esophagectomy may improve the microcirculation of the oral side of the gastric tube.