Gastric conditioning.
The etiology of esophagogastric anastomotic leaks is often multifactorial. However, occult ischemia of the gastric fundus is an important cause. In gastric conditioning, preliminary partial gastric devascularization is carried out 2-3 weeks before construction of the esophagogastric anastomoses. Gastric vascularity improves over this time. In animal studies, gastric conditioning has reduced the incidence of anastomotic leaks. Clinically, the concept of gastric conditioning can be used in several ways. Esophagectomy can be done at one stage, then a cervical esophagogastric anastomosis can be completed as a second-stage procedure. Pre-esophagectomy angiographic gastric artery embolization is another method of gastric conditioning. Finally, laparoscopic partial gastric devascularization can be done at the time of laparoscopic cancer staging. For gastric conditioning to be clinically useful, the benefit from reduction in leaks must be greater than the costs and morbidity of the conditioning procedure itself.
Urschel
J D
JD
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York, USA.
D000714:Anastomosis, Surgical; D000818:Animals; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016629:Esophagectomy; D006801:Humans; D013270:Stomach / Q000503:physiopathology*