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Laparoscopic devascularization of the lower esophagus and upper stomach: experimental study in the pig
Ibrahim Abdelkader Salama1, Amr Helmy, Raymond Connolly
1Department of Surgery, New England Medical Center, Tufts University, Boston, Massachusetts 02111, USA.
Background:
Esophagogastric devascularization is an alternative treatment for bleeding gastroesophageal varices. The aim of this experimental study was to develop an approach for laparoscopic devascularization of the lower esophagus and upper stomach.
Materials And Methods:
We used six swine pigs weighing 25 to 25 kg. With the use of five trocars, the steps of the procedure are as follows: (1). dissection of the gastroesophageal junction and mobilization of the esophagus; (2). encircling the abdominal esophagus with umbilical tape; (3). devascularization of the fundus and upper two thirds of the greater curvature of the stomach; and (4). identification and ligation of the left gastric vessels and devascularization of the lesser curvature of the stomach.
Results:
The mean operative time was 100 minutes (80-120 minutes), and the mean blood loss was 60 mL (40-80 mL). All procedures were completed laparoscopically.
Conclusion:
Laparoscopic devascularization of the lower esophagus and upper stomach is a technically feasible procedure.