Related Experiment Video
Updated: Jul 6, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Functional capillary density in ischemic conditioning: implications for esophageal resection with the gastric conduit
Christof Mittermair1, Alexander Klaus, Stephan Scheidl
1Department of General and Transplant Surgery, Medical University Innsbruck, Innsbruck, Austria.
Background:
Ischemia may lead to leakage at the esophagogastric anastomosis after esophagectomy. The aim of this study was to investigate time dependent changes of gastric microcirculation after ischemic conditioning.
Methods:
Twenty male Lewis rats were used and analyzed in 3 study groups and 1 control group. Group 1 (n = 5) underwent ligation of the left gastric artery and intravital fluorescence microscopy (IVM) on day 0; group 2 (n = 5) underwent IVM at 28 days after ligation of the LGA; and group 3 (n = 5) underwent IVM at 56 days after ligation of the LGA. The controls (n = 5) underwent sham surgery and IVM at 28 days thereafter. IVM was used to analyze gastric microcirculation by means of functional capillary density.
Results:
Ligation of the LGA immediately led to significant reduction of perfusion at the lesser (100.5 +/- 3.1 microm/mm(2) vs 220.4 +/- 7.4 microm/mm(2); P <.001) and greater curvatures (195.1 +/- 7.9 microm/mm(2) vs 234.1 +/- 9.4 microm/mm(2); P = .013). During 28 days, microcirculation at the lesser curve ameliorated (164.9 +/- 12.8 microm/mm(2)) and reached normal values after 56 days (215.8 +/- 7.4 microm/mm(2)). At the greater curve, microcirculation was improved during 4 (261.3 +/- 8 microm/mm(2)P = .039) and 8 weeks (317.9 +/- 10.3 microm/mm(2); P <.001 vs control).
Conclusions:
Gastric microperfusion continuously improves after partial devascularization. The results support further clinical studies to optimize gastric ischemic conditioning in patients undergoing esophagectomy.
