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Wound healing of laparoscopic esophageal myotomy with or without an added gastric patch
J L M C Azevedo1, F O Kozu, O Azevedo
1Division of Experimental Surgery, Department of Surgery, Federal University of São Paulo, R. Botucatu, 740-Prédio da Cirurgia Experimental-CEP, São Paulo, 04023-900, Brazil. jozevedo.dcir@epm.br
Background:
The purpose of this research is to compare the wound healing of the laparoscopic esophagomyotomy with and without a gastric patch.
Methods:
Twelve male pigs were distributed into two groups of six animals. Esophagomyotomy was performed in group A. A gastric patch was associated to the myotomy in group B. On the 21st postoperative day, lumen molding was accomplished to determine the index of stenosis (IS) at the area of myotomy (AM). Macroscopic and microscopic aspects of wound healing were also studied at AM. Three microscopic morphologic patterns were defined for morphometric evaluation: leukocytes (constituted by polymorphonuclear and mononuclear cells), new endothelial cells, and collagen fibers.
Results:
There was a longer operative duration in group B (93.6 min) than in group A (45 min). At AM, IS was negative (lumen increased) and equivalent in both groups: -11.1% in group A and -12.7% in group B. Mesotelial epithelium covering RM was observed in group A. Inflammatory reaction was greater in group B in comparison with group A (leuCocytes: 22 cells versus 8.6; fibrosis: 25.5 fibers versus 15.6; granulation tissue: 18.7 vessels versus 9.7).
Conclusion:
Esophagomyotomy followed by gastric patch does not heal adequately and is worsened by the presence of foreign body granulomas around stitches. Myotomy without gastric patch is faster and causes lower inflammation. Myotomy alone or with gastric patch does not lead to esophageal stenosis at RM and does not lead to restoration of the esophageal musculature continuity.
