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05.05.2016 | Original Article | Ausgabe 2/2016

Updates in Surgery 2/2016

Intra-operative hypotensive episodes may be associated with post-operative esophageal anastomotic leak

Zeitschrift:
Updates in Surgery > Ausgabe 2/2016
Autoren:
Uberto Fumagalli, Alessandra Melis, Jana Balazova, Valeria Lascari, Emanuela Morenghi, Riccardo Rosati
Wichtige Hinweise
Paper presented at ISDE World Congress—Montreal, September 2014.

Abstract

This study aims to report the hypotensive episodes (HEs) during esophagectomy and their influence on the occurrence of anastomotic leak. Eighty-four patients underwent esophagectomy with gastric pull-up. Pre-, intra-, and post-operative data were prospectively collected. HEs were defined by systolic pressure decreasing more than 30 % of the basal value for more than 5 min. Nineteen patients had intra-operative HEs (22.6 %). HEs were significantly more frequent in patients undergoing prone esophagectomy (P = 0.001) and those with an epidural catheter (EC) (P = 0.04) used during surgery. Among them, 15 were treated with vasopressors. There were six severe post-operative anastomotic leaks, which required surgery; leaks were significantly more common in patients with intra-operative HEs (21 vs 3.1 %; P = 0.02), especially those treated with vasopressive agents (20 vs 0 %; P = 0.008). Intra-operative use of EC can, in certain conditions, significantly influence gastric blood flow due to HEs. A higher incidence of severe leak occurred in patients experiencing intra-operative HEs. Several factors can lead to intra-operative HEs, and the perioperative use of an EC should be carefully evaluated.

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