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Ischemic conditioning of the rat stomach: implications for esophageal replacement with stomach
1Division of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001.
Background:
Esophagectomy, with gastric pull up replacement, is not uncommonly complicated by leakage from the esophagogastrostomy anastomosis. Occult ischemia of the mobilized gastric fundus is a major etiologic factor in anastomotic leakage.
Objective:
To test the hypothesis that tissue perfusion in a partially devascularized stomach will improve over time by a process of ischemic conditioning ("delay" phenomenon). EXPERIMENTAL DESIGN COLON: Laboratory study of partial gastric devascularization in rats.
Animals:
Twenty rats.
Interventions:
Partial gastric devascularization was achieved by ligation of the left gastric artery.
Measures:
Gastric perfusion was measured with a laser-Doppler flowmeter (in tissue perfusion units, TPU). Perfusion measurements were made at baseline, after vessel ligation, at 7 days, and at 14 days.
Results:
Perfusion immediately after vessel ligation (23.8 +/- 6.0 TPU) was significantly lower than baseline gastric tissue perfusion (88.4 +/- 9.8 TPU) (p < 0.00001). After 7 days, tissue perfusion had increased (54.4 +/- 9.2 TPU), but it was significantly lower than baseline values (p < 0.00005). After 14 days, perfusion was increased (71.7 +/- 8.6 TPU) compared to 7 day measurements (p < 0.001), but it was still significantly lower than baseline gastric tissue perfusion (p < 0.002). Nevertheless, 14 day perfusion was 81% of baseline values.
Conclusions:
After partial devascularization, gastric perfusion steadily improves by a process of ischemic conditioning ("delay" phenomenon). The principle of ischemic conditioning may be clinically applicable to the gastric pull up operation.