Preoperative Laparoscopic Ligation of the Left Gastric Vessels in Preparation for Esophagectomy

Ischemic conditioning shows a time-dependant influence on the fate of the gastric conduit after minimally invasive esophagectomy

“…Holscher et al [24] ligated the left gastric artery 5 days preoperatively out of a concern for the formation of adhesions, which occurs after about 7 days, and also from their own experiments seeking a mucosal pressure of carbon dioxide (pCO 2 ) recovery, which occurs in 4 to 5 days [44]. Nguyen et al [23] performed a laparoscopic ischemic conditioning at a mean of 12 days before MIO and showed a benefit [23]. However, the evidence base available currently is insufficient for drawing robust conclusions, and the timing for performing ischemic conditioning needs to be ascertained.…”

“…1 Postoperative gastric conduit failure [23]. The dotshaded area represents a segment of necrotic, nonviable conduit…”

“…Akiyama et al [22] showed a reduced leak rate (2 vs. 8% in a control group) and improved perfusion of the conduit (67 vs. 33% in a control group) more than 1 week after embolization of the left gastric, right gastric, and splenic arteries. Nguyen et al [23] reported no anastomotic leaks in nine patients whose left gastric artery had been ligated at staging laparoscopy 2 weeks before MIO. Holscher et al [24] demonstrated that laparoscopic ligation of the left gastric artery 5 days before open intrathoracic reconstruction may reduce conduit-related morbidity.…”

Short-term outcomes following total minimally invasive oesophagectomy

“…There is some evidence that ischaemic conditioning of the stomach may improve the vascularity of the gastric conduit 17,19,20 and the authors have recently started to evaluate ischaemic conditioning of the stomach by LGA ligation at staging laparoscopy 18 . Two-field lymphadenectomy at MIO in this series yielded a comparable nodal harvest to that reported from open radical two-field oesophagectomy, with a median recovery of 22 nodes 30 .…”

“…The median overall lymph node harvest was 21 (range 7-48, interquartile range [17][18][19][20][21][22][23][24][25][26]. Lymph node count during the study is shown in Fig.…”