title: Ischemic conditioning of the rat stomach: implications for esophageal replacement with stomach.
abstract: 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.
  
  
  METHODS
  Twenty rats.
  
  
  METHODS
  Partial gastric devascularization was achieved by ligation of the left gastric artery.
  
  
  METHODS
  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.
authors.affiliation: Division of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001.
authors.forename: J D
authors.initials: JD
authors.lastname: Urschel
mesh_terms: D000818:Animals; D016629:Esophagectomy; D007511:Ischemia / Q000503:physiopathology*; D017078:Laser-Doppler Flowmetry; D051381:Rats; D012039:Regional Blood Flow / Q000502:physiology; D013270:Stomach / Q000098:blood supply* / Q000637:transplantation; D013524:Surgical Flaps / Q000379:methods; D013997:Time Factors