Jd. Urschel et al., GASTRIC DISTENSION EXACERBATES ISCHEMIA IN A RODENT MODEL OF PARTIAL GASTRIC DEVASCULARIZATION, The American journal of the medical sciences, 314(5), 1997, pp. 284-286
Occult ischemia of he mobilized gastric fundus is an important etiolog
ic factor for esophagogastric anastomotic leaks after esophagectomy. P
ostoperative gastric distention is another possible predisposing facto
r for anastomotic leakage. We hypothesized that gastric distention cou
ld worsen gastric ischemia. To test this hypothesis, gastric tissue pe
rfusion was studied in 20 Sprague-Dawley rats. Baseline serosal gastri
c tissue perfusion was measured by laser-Doppler flowmetry at a point
10 mm distal to the gastroesophageal junction. Perfusion was measured
after left gastric artery occlusion, gastric distention to 20 cm water
pressure, and combined left gastric artery occlusion and gastric dist
ention. Gastric tissue perfusion (in tissue perfusion units, TPU) was
64.2 +/- 9.1 TPU at baseline measurement, 18.6 +/- 4.3 TPU after left
gastric artery occlusion, 22.0 +/- 4.1 TPU after gastric distention, a
nd 7.8 +/- 1.8 TPU after combined left gastric artery occlusion and ga
stric distention. Distention (P < 0.0001) and arterial occlusion (P <
0.0001) both reduced gastric tissue perfusion; of the two, arterial oc
clusion produced the greatest reduction in perfusion (P < 0.021). The
combination of distention and arterial occlusion caused greater reduct
ion in gastric perfusion than either factor alone (P < 0.0001). In thi
s model, gastric distention exacerbated the ischemia produced by parti
al gastric devascularization. In clinical esophageal surgery, postoper
ative gastric distention may similarly potentiate the ischemic effects
of gastric transposition for esophageal reconstruction.