Laparoscopic partial gastric transection and devascularization in order to enhance its flow

Federico Cuenca-Abente, Ahmad Assalia, Gianmattia del Genio, Tomasz Rogula, David Nocca, Kazuki Ueda, Michel Gagner, Federico Cuenca-Abente, Ahmad Assalia, Gianmattia del Genio, Tomasz Rogula, David Nocca, Kazuki Ueda, Michel Gagner

Abstract

Background: Esophagogastric fistula following an esophagectomy for cancer is very common. One of the most important factors that leads to its development is gastric ischemia. We hypothesize that laparoscopic gastric devascularization and partial transection is a safe operation that will enhance the vascular flow of the fundus of the stomach.

Method: Our study included eight pigs. Each animal had two operations. In the first one, a laparoscopic gastric devascularization and mobilization took place. Vascular flow was measured previous to the procedure and immediately after it with a laser doppler (endoscopic probe). After three weeks, a second operation took place. We re-measured the vascular flow and sent a sample of gastric fundus for histopathologic evaluation.

Results: The gastric fundus showed signs of neovascularization after both macroscopic and microscopic evaluation. These findings correlated with laser doppler measurements.

Conclusion: Laparoscopic gastric devascularization and partial transection is a safe procedure that increases the vascular flow of the stomach in a three week period. This finding can have a positive impact in terms of decreasing fistula formation.

Figures

Figure 1
Figure 1
Partial gastric transection after being devascularized.
Figure 2
Figure 2
Histopathologic evaluation of gastric tissue. The graphic shows the increase in the number of vessels in the neovascularized portion of the stomach (most distal part of the fundus).
Figure 3
Figure 3
Initial decrease in perfusion after devascularization, and its increase after a three period week.

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