Vascular flow of the gastric fundus after arterial devascularization: an experimental study.
BACKGROUND
The main complication of transhiatal subtotal esophagectomy with esophagogastric reconstruction is anastomotic leak, which is responsible for a large number of postoperative deaths. It is believed that this complication is due to gastric fundus ischemia caused by the sectioning of the short gastric, left gastric, and left gastro-omental arteries. The literature, however, presents controversies. An experimental study was performed with the aim of evaluating the vascularization of the gastric fundus following sectioning of these arteries.


METHODS
Forty mongrel dogs were distributed into 2 groups: a control group consisting of 15 dogs subjected to surgical simulation and an experimental group consisting of 25 dogs that underwent sectioning of these arteries. Fluorescein testing, gastric mummification, and morphometric image analysis were performed on both groups.


RESULTS
In comparison with the control group, fluorescein testing on the experimental group demonstrated time-delayed fluorescence in the gastric fundus and partial coloring, (P < 0.001). Image analysis on the mummified gastric samples demonstrated significant reduction in blood vessels in the gastric fundus of the experimental group (P < 0.001).


CONCLUSIONS
We conclude that sectioning of the short gastric, left gastric, and left gastro-omental arteries causes reduction in blood circulation and in the quantity of blood vessels on the anterior side of the gastric fundus of dogs.
Gomes
Marise
M
Fifty Medical Research, São Paulo, Brazil.
Ramacciotti
Eduardo
E
Miranda
Fausto
F
Henriques
Alexandre Cruz
AC
Fagundes
Djalma José
DJ
D000714:Anastomosis, Surgical / Q000009:adverse effects; D000818:Animals; D001158:Arteries / Q000601:surgery; D004285:Dogs; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005748:Gastric Fundus / Q000098:blood supply*; D007511:Ischemia / Q000209:etiology*; D008297:Male