RETRACTED ARTICLE: Incidence and Risk Factors of an Intraoperative Arrhythmia in Transhiatal Esophagectomy

Abstract

Background:Transhiatal esophagectomy (THE) is a widely used technique for carcinoma of the esophagus and other conditions, such as benign strictures and motility disorders.Objectives:The aim of our study was to quantify the incidence, predisposing factors, as well as types of arrhythmias in transhiatal esophagectomy.Patients and Methods:In this prospective study, we selected 61 patients undergoing transhiatal esophagectomy during 2012 - 2013 in our hospital. The demographic information, site of the tumor, cardiopulmonary function, transfusion, preoperative and postoperative complications (i.e. arrhythmias, hypotension), operation time, duration of mediastinal manipulation, amount of hemorrhage, volume loss, volume intake, mean systolic and diastolic pressure, and death rate were evaluated by chi-square, Fisher’s exact test, ANOVA, and t-tests.Results:The mean age of patients was 61.24 ± 11.48. In the study group, 8.2% of the patients before, 50.8% during, and 11.2% after mediastinal manipulation showed arrhythmia. Tumor location, the need for transfusion, pathology of the tumor, presence of arrhythmia before the operation, FEV1 (Forced Expiratory Volume) > 2 liters, and mean volume intake were significantly different between the patients with and without arrhythmia. Hypotension was shown in 8.2% of the patients before and 57.7% during mediastinal manipulation. Manipulation times, volume loss, mean systolic and diastolic blood pressure before the operation, and FEV1 > 2 liters were statistically significant in occurrence of hypotension.Conclusions:Our data showed that the amount of hydration, transfusion, pre-manipulation arrhythmia, and pulmonary function should be controlled to decrease the risk of arrhythmias. Minor mediastinal manipulation, few intraoperative hemorrhages, improvement of pulmonary function, and careful blood pressure monitoring can reduce the risk of hypotension.

Pediatric esophageal substitution by gastric pull-up and gastric tube

“…[ 13 18 19 ] In adult patients undergoing trans-hiatal esophagectomy, a high incidence of arrhythmias (up to 50%) was reported during the phase of mediastinal manipulation, however they were transient and associated simultaneously with hypotension due to impaired cardiac filling. [ 20 21 ] In pediatric patients undergoing posterior mediastinal GPU, tachycardia or tachyarrhythmias may persist into postoperative period and may be associated with hypertension as observed in two of our cases. Similarly, respiratory distress may occur due to the bulk of the stomach in the chest and tracheal edema resulting from the surgical dissection being just behind the membranous trachea.…”