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Introduction: Several complications after esophagectomy with gastric pull-up are associated with ischemia within the gastric conduit. We aimed to assess conduit morbidity in a two stage operation involving laparoscopic ischemic preconditioning of the stomach prior to esophagectomy and gastric pull-up, compared to a single stage operation.

Methods: We conducted a retrospective review comparing conduit morbidity of 63 consecutive patients who underwent an esophagectomy for Stage I-III esophageal cancer. Twenty three patients received pre-conditioning, which included laparoscopic ligation of the left and short gastrics, celiac node dissection, and jejunostomy tube placement, followed by formal resection and reconstruction between 3-9 days later. Forty patients underwent thoracotomy, esophagectomy and gastric pull-up without pre-conditioning.

Results: The two groups were similar with respect to gender and mean age. More patients in the preconditioned group received neoadjuvant therapy (88% vs 40%, p<0.0001). There were no conversions to open in the pre-conditioned group. Mean time interval between the conditioning procedure and esophagectomy was 6.6 ± 1.5 days. Seventeen percent of the preconditioned group demonstrated ischemic changes along the fundus leading to modification of the planned transection line. There were significantly less post-operative strictures in the preconditioned group (8% vs 32%, P<0.03), and a trend toward less anastomotic leaks (13% vs 26%, P<0.20), and delayed gastric emptying (25% vs 45%, P<0.12). There was no statistical difference between groups in terms of morbidity or mortality. Mean follow-up in months was 11.4 ± 8.9 in the preconditioned group, and 26.0 ± 27.6 (P<0.02) in the single-stage group.

Conclusions: Laparoscopic ischemic conditioning results in less strictures and a trend toward less gastric conduit morbidity (anastomotic leaks, delayed gastric emptying) when compared to single-stage esophagectomy and gastric pull-up.