ESOPHAGOGASTRIC ANASTOMOTIC LEAKS - THE IMPORTANCE OF GASTRIC ISCHEMIA AND THERAPEUTIC APPLICATIONS OF GASTRIC CONDITIONING

The etiology of eophagogastric anastomotic leaks is often multifactori al. However, occult ischemia of the gastric fundus is an important cau se. In gastric conditioning, preliminary partial gastric devasculariza tion is done 2-3 weeks before construction of the esophagogastric anas tomoses, Gastric vascularity improves over this time. In animal stud i es, gastric conditioning has reduced the incidence of anastomotic leak s. Clinically, the concept of gastric conditioning can be used in seve ral ways. Esophagectomy can be done at one stage, and then a cervical esophagogastric anastomosis can be completed as a second-stage procedu re. Preesophagectomy angiographic gastric artery embolization is anoth er method of gastric conditioning. Finally, laparoscopic partial gastr ic devascularization can be done at the time of laparoscopic cancer st aging. For gastric conditioning to be clinically useful, the benefit f rom reduction in leaks must be greater than the costs and morbidity of the conditioning procedure itself.