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Experimental model of laparoscopic gastric ischemic preconditioning prior to transhiatal esophagectomy

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Abstract

Background

Cervical esophagogastric anastomotic disruption following transhiatal esophagectomy (THE) is a significant problem. Gastric tip ischemia is a primary cause of anastomotic failure. We examined gastric tip blood flow when laparoscopic “ischemic preconditioning” was attempted by selectively ligating the short gastric (SG) vessels or both the left and short gastric (LG/SG) vessels prior to THE.

Methods

Seventeen (25 kg) mongrel dogs underwent laparoscopy followed 3 weeks later by THE. Three groups were studied: control group = laparoscopy only, no preconditioning (n = 6); SG group = laparoscopic ligation of SG vessels only (n = 5); and LG/SG group = laparoscopic ligation of LG and SG vessels (n = 6). Tissue blood flow was assessed using the fluorescent microsphere method. The initial microsphere injections occurred prior to pneumoperitoneum and upon completion of the laparoscopy. At the second operation, transhiatal esophagectomy was performed and microsphere blood flow assessment occurred after induction of anesthesia, after mobilization of the stomach, and after completion of the cervical esophagogastric anastomosis. The animals were euthanized and regional gastric tissue was analyzed for microsphere estimates of blood flow. Differences in blood flow were evaluated using Student’s t test.

Results

The mean baseline gastric blood flow was 0.58 ml/min/g. After THE, the proximal gastric blood flow fell to 16% of baseline in control and 22% in SG, but was reduced to only 60% of baseline in LG/SG. This relative preservation of blood flow among the LG/SG group approached significance compared with the laparoscopy-only (control) group (P = 0.07). Ligation of SG vessels alone provided no preservation of proximal gastric blood flow following THE.

Conclusion

Preoperative “ischemic preconditioning” through ligation of both the short and left gastric vessels may achieve preservation of blood flow to the gastric tip. Preconditioning during laparoscopic staging of esophageal carcinoma may be considered to reduce anastomotic complications following esophagectomy.

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Acknowledgment

Disclosures

Drs. Beck, Malay, Gagné, Fowler, and Landreneau have no conflicts of interest or financial ties to disclose.

Author information

Author notes

  1. Sandra M. Jones Beck

    Present address: Department of Surgery, University of Kentucky Medical Center, Lexington, KY, 40536, USA

  2. Mary Beth Malay

    Present address: Department of Surgery, Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

  3. Daniel J. Gagné

    Present address: Bariatric Surgery Center, West Penn Allegheny Health System, Pittsburgh, PA, 15212, USA

  4. Dennis L. Fowler

    Present address: Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA

  5. Rodney J. Landreneau

    Present address: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA

Authors and Affiliations

  1. Allegheny General Hospital Minimally Invasive Surgery Center, Pittsburgh, PA, 15212, USA

    Sandra M. Jones Beck, Mary Beth Malay, Daniel J. Gagné, Dennis L. Fowler & Rodney J. Landreneau

  2. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Professional Office Building 1, UPMC Shadyside Medical Center, 5200 Centre Avenue, Pittsburgh, PA, 15232, USA

    Rodney J. Landreneau

Authors
  1. Sandra M. Jones Beck
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Correspondence to Rodney J. Landreneau.

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Jones Beck, S.M., Malay, M.B., Gagné, D.J. et al. Experimental model of laparoscopic gastric ischemic preconditioning prior to transhiatal esophagectomy. Surg Endosc 25, 2470–2477 (2011). https://doi.org/10.1007/s00464-010-1568-y

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  • DOI: https://doi.org/10.1007/s00464-010-1568-y

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