Laparoscopic devascularization of the lower esophagus and upper stomach: experimental study in the pig.
BACKGROUND
Esophagogastric devascularization is an alternative treatment for bleeding gastroesophageal varices. The aim of this experimental study was to develop an approach for laparoscopic devascularization of the lower esophagus and upper stomach.


METHODS
We used six swine pigs weighing 25 to 25 kg. With the use of five trocars, the steps of the procedure are as follows: (1). dissection of the gastroesophageal junction and mobilization of the esophagus; (2). encircling the abdominal esophagus with umbilical tape; (3). devascularization of the fundus and upper two thirds of the greater curvature of the stomach; and (4). identification and ligation of the left gastric vessels and devascularization of the lesser curvature of the stomach.


RESULTS
The mean operative time was 100 minutes (80-120 minutes), and the mean blood loss was 60 mL (40-80 mL). All procedures were completed laparoscopically.


CONCLUSIONS
Laparoscopic devascularization of the lower esophagus and upper stomach is a technically feasible procedure.
Salama
Ibrahim Abdelkader
IA
Department of Surgery, New England Medical Center, Tufts University, Boston, Massachusetts 02111, USA.
Helmy
Amr
A
Connolly
Raymond
R
Schwaitzberg
Steven D
SD
D000818:Animals; D016063:Blood Loss, Surgical; D004195:Disease Models, Animal; D004932:Esophageal and Gastric Varices / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply*; D006471:Gastrointestinal Hemorrhage / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D013270:Stomach / Q000098:blood supply*; D013552:Swine