Omentoplasty reinforcement of esophagogastric anastomoses in rats

Esophagogastric anastomotic leaks complicate 5-20% of esophagectomies for esophageal cancer, and they are responsible for approximately one-third of perioperative deaths. Omentoplasty reinforcement has been recommended for esophagogastric anastomoses, but there is little evidence to support this practice. An animal experiment was done to test the hypothesis that omentoplasty reinforcement of esophagogastric anastomoses would have a beneficial effect on healing.

Twenty-eight rats had single layer esophagogastric anastomoses constructed using interrupted 7-0 polypropylene sutures. In the experimental group (14 rats) the anastomoses were covered with omentum. This was not done in the control group (14 rats). Rats were killed 1 week after surgery and their anastomoses were excised, mounted in a tensiometer, and distracted at 10 mm/min to measure breaking strength. After that, anastomotic tissue was subjected to hydroxyproline analysis (an indicator of wound collagen).

There were no anastomotic leaks. Esophagogastric anastomotic breaking strength was 3.45+/-0.63 N in the omentoplasty rats and 3.86+/-0.85 N in the control rats (p=0.24, not significant). Esophagogastric anastomotic tissue hydroxyproline concentration was 388.7+/-33 nmol/mg in the omentoplasty rats and 463.9+/-56 nmol/mg in the control rats (p=0.001).

Omentoplasty reinforcement of esophagogastric anastomoses did not have any beneficial effect on anastomotic healing in this animal experiment.