Abstract
BackgroundEsophagogastric fistula following an esophagectomy for cancer is very common. One of the most important factors that leads to its development is gastric isquemia. We hypothesize that laparoscopic gastric devascularization and partial transection is a safe operation that will enhance the vascular flow of the fundus of the stomach.MethodOur study included eight pigs. Each animal had two operations. In the first one, a laparoscopic gastric devascularization and mobilization took place. Vascular flow was measured previous to the procedure and immediately after it with a laser doppler (endoscopic probe). After three weeks, a second operation took place. We re-measured the vascular flow and sent a sample of gastric fundus for histopathologic evaluation.ResultsThe gastric fundus showed signs of neovascularization after both macroscopic and microscopic evaluation. These findings correlated with laser doppler measurements.ConclusionLaparoscopic gastric devascularization and partial transection is a safe procedure that increases the vascular flow of the stomach in a three week period. This finding can have a positive impact in terms of decreasing fistula formation.
Highlights
Esophagogastric fistula following an esophagectomy for cancer is very common
Laparoscopic gastric devascularization and partial transection is a safe procedure that increases the vascular flow of the stomach in a three week period
This finding can have a positive impact in terms of decreasing fistula formation
Summary
Esophagogastric fistula following an esophagectomy for cancer is very common. We hypothesize that laparoscopic gastric devascularization and partial transection is a safe operation that will enhance the vascular flow of the fundus of the stomach. Esophagogastric anastomotic leakage is a major cause of morbidity and mortality in patients who underwent an esophagectomy [1,2,3]. Research has been done [7] showing a fall in gastric Pt O2 following gastric devascularization, but not after its mobilization. Some articles [8,9,10] describe pre-operative embolization as a way of increasing the vascularization of the gastric fundus. Others [11,12] hypothesize surgical devascularization of the gastric fundus and delayed anastomosis as a potential solution. A two stage esophagectomy has been described, but transposing the (page number not for citation purposes)
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