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Master Thesis

Conditionnement ischémique du transplant gastrique avant œsophagectomie, expérience sur 10 ans

Abstract : Objectives: Gastric ischemic conditioning prior to esophagectomy has been shown to reduce anastomotic failure but its use is still debated. The aim of this study was to evaluate all anastomotic outcomes in patients who underwent esophagectomy after gastric preconditioning. Material and methods: We retrospectively included all esophagectomies starting from January 2010 to September 2021. Ischemic conditioning of the gastric transplant by embolization of left and right gastric artery and splenic artery was performed one month prior to esophagectomy in all patients. Primary outcomes included all postoperative anastomotic complications and secondary outcome was the preconditioning-related morbidity. Results: Eighty patients underwent a gastric ischemic conditioning without any significant complication – with 93% of grade I complications – ischemic conditionning was deemed complete in 68 patients (85%), with a total of 11 anastomotic leaks (13.8%), 8 of them occurred in three-stage esophagectomy. We did not experience any conduit failure. Only 5 strictures (6%) occurred, a median of 2 balloon dilations were performed. Overall, 90 days mortality was 6% and occurred in 5 patients, 3 of them following an anastomotic leak. Conclusion: Gastric ischemic conditioning by preoperative arterial embolization appears to be a safe procedure and can therefore be performed in everyday practice. In our experience, it appears to be associated with low stricture rates and the suppression of conduit failure. Its effect on overall anastomotic leaks was mitigated with promising results in Iwor-Lewis esophagectomies, however.
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Master Thesis
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Contributor : Jean-Hugues Morneau Connect in order to contact the contributor
Submitted on : Friday, September 10, 2021 - 4:26:26 PM
Last modification on : Sunday, September 12, 2021 - 3:16:24 AM


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  • HAL Id : dumas-03341224, version 1


Benjamin Paul René Jacques Chappuy. Conditionnement ischémique du transplant gastrique avant œsophagectomie, expérience sur 10 ans. Médecine humaine et pathologie. 2021. ⟨dumas-03341224⟩



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