GASTRIC DISTENSION EXACERBATES ISCHEMIA IN A RODENT MODEL OF PARTIAL GASTRIC DEVASCULARIZATION

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.