From the Guidelines
The blood supply of the thoracic stomach used for esophageal replacement primarily depends on the right gastroepiploic artery. When the stomach is used as a conduit for esophageal replacement in a thoracic position, its blood supply primarily depends on the right gastroepiploic artery, as the left gastric artery is typically divided during mobilization, and the short gastric vessels are insufficient to provide adequate blood supply to the entire stomach conduit 1.
Key Points to Consider
- The stomach is mobilized and pulled up into the chest to replace the diseased esophagus, and the right gastroepiploic artery becomes the dominant blood supply for the gastric tube.
- The left gastric artery is typically divided during mobilization, and the short gastric vessels are insufficient to provide adequate blood supply to the entire stomach conduit.
- The right gastroepiploic artery, which runs along the greater curvature of the stomach, must be carefully preserved during surgery to ensure viability of the stomach in its new position.
- The left gastroepiploic artery may contribute to the blood supply but is not the primary vessel, as noted in the context of esophageal and esophagogastric junction cancers 1.
Clinical Implications
- Understanding this vascular anatomy is crucial for successful esophageal replacement surgery to prevent ischemia and necrosis of the gastric conduit.
- The choice of surgical approach, such as Ivor Lewis esophagogastrectomy or transhiatal esophagogastrectomy, may also impact the blood supply to the gastric conduit, and the right gastroepiploic artery remains a critical vessel to preserve 1.
From the Research
Blood Supply to the Thoracic Stomach
The blood supply to the thoracic stomach used for esophageal replacement is a critical factor in preventing ischemia and ensuring a successful reconstruction. The options provided are:
- The left gastric artery
- The short gastric vessels
- The right gastroepiploic artery
- The left gastroepiploic artery
Relevant Studies
Studies have shown that the blood supply to the gastric conduit is essential for a successful esophageal reconstruction 2, 3, 4, 5, 6.
- A study published in 2015 found that preserving the right gastroepiploic vessels is crucial in preventing conduit ischemia 2.
- Another study published in 2024 emphasized the importance of sufficient blood supply to the conduit and discussed various techniques to ensure adequate perfusion, including the use of indocyanine green angiography 3.
- A study published in 2007 demonstrated that laparoscopic ischemic conditioning of the stomach can improve gastric perfusion and reduce the risk of anastomotic leakage 4.
- A study published in 2006 described a technique of laparoscopic ligation of the left gastric vessels to improve collateral blood flow to the gastric conduit 5.
- A study published in 1998 found that the vascularization of a gastric tube is affected by its diameter, with narrower tubes showing poorer vascularization, especially at the site of the anastomosis 6.
Key Findings
Key findings from these studies include:
- The importance of preserving the right gastroepiploic vessels to prevent conduit ischemia 2.
- The use of techniques such as indocyanine green angiography to ensure adequate perfusion of the gastric conduit 3.
- The potential benefits of laparoscopic ischemic conditioning of the stomach in improving gastric perfusion and reducing the risk of anastomotic leakage 4.
- The role of the left gastric vessels in supplying blood to the gastric conduit and the potential benefits of laparoscopic ligation of these vessels 5.
- The impact of gastric tube diameter on vascularization, with narrower tubes showing poorer vascularization 6.
Blood Supply Options
Based on these studies, the most relevant blood supply option for the thoracic stomach used for esophageal replacement is: