Microcirculatory changes associated with gastric tube formation in the pig

The standard reconstruction after esophagectomy is the formation of a gastric tube with partial devascularization of the lesser curvature. The purpose of this experimental study was to establish an animal model in order to analyze microcirculation associated with the formation of a gastric tube. In 17 pigs tissue perfusion was measured with a laser Doppler imager (LDI) and partial tissue oxygen pressure (ptO(2)) with a Clark-type polarographic oxygen electrode before and after formation of a gastric tube in well-defined regions of the stomach. The operative procedure included the dissection of the left gastric and short gastric arteries; the left gastroepiploic artery along the greater curvature was preserved. LDI and ptO(2) baseline measurement were significantly lower in the fundus compared to the antrum and corpus. After formation of a gastric tube LDI and ptO(2) baseline values calculated from the mean measurements of the antrum, corpus and fundus decreased significantly (LDI: 1,099 PU +/- 228 SD to 601 PU +/- 125 SD, p < 0.0001; ptO(2): 50.8 mm Hg +/- 5.9 SD to 40.7 mm Hg +/- 9.3 SD, p = 0.0003). Microcirculatory changes did not correlate with changes of cardiac output and systemic vascular resistance. This study suggests that the pig is an appropriate model to investigate microcirculation associated with gastric tube formation. Its use for esophageal reconstruction by pull-up of the gastric interponate is limited.