Vascular Flow of the Gastric Fundus After Arterial Devascularization: An Experimental Study

Gomes, Marise; Ramacciotti, Eduardo; Miranda, Fausto; Henriques, Alexandre Cruz; Fagundes, Djalma José

doi:10.1016/j.jss.2008.04.016

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…It has been hypothesized that performing an LGD procedure prior to an oesophagectomy allows for increased perfusion to the conduit through the development of a collateral blood supply to the future neo-oesophagus [ 9 , 21 , 26 – 28 ]. Studies performed in rats and pigs have demonstrated increased blood flow through the remaining arteries [ 29 – 32 ]. It is postulated that increased gastric conduit perfusion is through microcirculatory changes within the stomach.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ischaemic conditioning of the gastric conduit prior to a hybrid mckeown oesophagectomy may not decrease the risk of anastomotic leak.

Hanna¹,

Mir²,

Williams³

et al. 2021

Videosurgery and Other Miniinvasive Techniques

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Introduction Morbidity associated with anastomotic leak after oesophagectomy is significant. Techniques to reduce this risk include ischaemic conditioning of the gastric conduit prior to oesophagectomy. Aim To quantify the rate of anastomotic leak after a hybrid minimally invasive McKeown oesophagectomy preceded by laparoscopic gastric devascularization (LGD). Material and methods We identified patients who had undergone neoadjuvant chemoradiotherapy followed by LGD and McKeown oesophagectomy and conducted a retrospective case series. The primary outcome was anastomotic leak, and secondary outcomes included common post-operative complications within 30 days. Results Eleven patients were identified. Seventy-three per cent were male, and 7 of 11 patients were age 70+ years. 91% of tumours were located in the lower oesophagus or gastroesophageal junction (GEJ), and 72% of the series had clinical stage of II–III. The median ischaemic conditioning time was 15 days. Eighteen per cent of patients developed an anastomotic leak, and all were managed non-operatively. One patient developed an anastomotic stricture. Three patients developed pneumonia. Three patients suffered wound infection at the site of the neck incision. One had respiratory failure requiring ventilator support. None required reoperation or readmission. There were no mortalities following either operation. Conclusions Laparoscopic ischaemic conditioning via LGD prior to a hybrid McKeown oesophagectomy for malignancy was associated with a leak rate similar to previously published data for a McKeown oesophagectomy without prior LGD.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic ischaemic conditioning of the gastric conduit prior to a hybrid mckeown oesophagectomy may not decrease the risk of anastomotic leak.

Hanna¹,

Mir²,

Williams³

et al. 2021

Videosurgery and Other Miniinvasive Techniques

View full text Add to dashboard Cite

show abstract

“…However, few studies analyzed how gastric blood flow and tissue perfusion change after sleeve gastrectomy. Gomes et al ( 19 ) evaluated gastric fundus ischemia caused by the sectioning of the short gastric, left gastric, and left gastro-omental arteries by using fluorescein testing and morphometric image analysis in mongrel dogs. This study was designed to investigate the causes of leak after transhiatal subtotal esophagectomy with esophagogastric reconstruction.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Bougie Diameters on Tissue Oxygen Levels After Sleeve Gastrectomy: A Randomized Experimental Trial

et al. 2018

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Background:Staple-line leak is the most frightening complication of laparoscopic sleeve gastrectomy and several predisposing factors such as using improper staple sizes regardless of gastric wall thickness, narrower bougie diameter and ischemia of the staple line are asserted.Aims:To evaluate the effects of different bougie diameters on tissue oxygen partial pressure at the esophagogastric junction after sleeve gastrectomy.Study Design:A randomized and controlled animal experiment with 1:1:1:1 allocation ratio.Methods:Thirty-two male Wistar Albino rats were randomly divided into 4 groups of 8 each. While 12-Fr bougies were used in groups 1 and 3, 8-Fr bougies were used in groups 2 and 4. Fibrin sealant application was also carried out around the gastrectomy line after sleeve gastrectomy in groups 3 and 4. Burst pressure of gastrectomy line, tissue oxygen partial pressure and hydroxyproline levels at the esophagogastric junction were measured and compared among groups.Results:Mortality was detected in 2 out of 32 rats (6.25%) and one of them was in group 2 and the cause of this mortality was gastric leak. Gastric leak was detected in 2 out of 32 rats (6.25%). There was no significant difference in terms of burst pressures, tissue oxygen partial pressure and tissue hydroxyproline levels among the 4 groups.Conclusion:The use of narrower bougie along with fibrin sealant has not had a negative effect on tissue perfusion and wound healing.

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“…The construction of a wide esophagogastric anastomotic lumen in rats promotes reflux and aspiration pneumonia. Therefore, some researchers handled this technical difficulties studying either esophageal or gastric wound healing as a surrogate for esophagogastric wound healing [18,19] or used larger animals, such as pigs, cats and dogs [20,21,22]. Using a side-to-side technique for esophagogastric anastomosis results in a bigger anastomotic lumen and preservation of the normal esophagogastric route but does not respect the anatomic and vascular situation after gastric tube formation and reconstruction by esophagogastric anastomosis, as described before in a rat model [23].…”

Section: Discussionmentioning

confidence: 99%

Model of Wound Healing for Esophagogastric Anastomoses in Rats

Drescher¹,

Vogt²,

Gabriel³

et al. 2012

Eur Surg Res

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Background: Anastomotic leakage after esophageal surgery is a significant cause of morbidity and mortality. Postoperative leakage of esophagogastric anastomosis has been reported in 2–30% of surgical patient, resulting in an increased need for reoperation and a high risk of subsequent esophageal stricture formation and fistula. So far, experimental investigations on major factors influencing the healing of esophageal anastomoses, e.g. neovascularization and collagen deposition, have been hindered by the lack of a functional rodent model. Methods: We developed a novel technique of gastric tube formation followed by end-to-end esophagogastric anastomosis in a rat model. Standardized anastomoses were carried out in 18 Brown-Norway rats and normal esophagogastric healing was studied by measuring anastomotic breaking strength 5 days after surgery. Results: Five animals showed an insufficiency of the esophagogastric anastomosis as determined by anastomotic leakage testing. Normal anastomotic healing was found in 10 animals. The anastomotic breaking strength was 1.93 ± 0.45 N. Conclusion: The rat model for performing esophagogastric anastomoses after gastric tube formation may serve as a functional and useful model in future research studies on microvascular and molecular processes of anastomotic healing.

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Vascular Flow of the Gastric Fundus After Arterial Devascularization: An Experimental Study

Cited by 10 publications

References 16 publications

Laparoscopic ischaemic conditioning of the gastric conduit prior to a hybrid mckeown oesophagectomy may not decrease the risk of anastomotic leak.

Laparoscopic ischaemic conditioning of the gastric conduit prior to a hybrid mckeown oesophagectomy may not decrease the risk of anastomotic leak.

The Effects of Bougie Diameters on Tissue Oxygen Levels After Sleeve Gastrectomy: A Randomized Experimental Trial

Model of Wound Healing for Esophagogastric Anastomoses in Rats

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