Ischemic conditioning of the rat stomach: implications for esophageal replacement with stomach.
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.
Urschel
J D
JD
Division of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York 14263-0001.
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