Long oesophageal gaps - a new surgical technique: an experimental study on lambs

The management of long gap oesophageal atresia remains a major challenge for the paediatric surgeon. In this experimental study on neonatal lambs, a Silastic tube was used to bridge a gap in the oesophagus. The Silastic tube was not fixed to the oesophageal edges but half a centimetre from the edge of the oesophagus. The oesophageal edges were left free to grow over the Silastic tube and bridge the gap. The aim of the study was to see whether the oesophageal edges would grow over the Silastic tube and form a continuous oesophagus.

Twelve neonatal lambs were included in the study. They were divided into 3 groups: Group A (control group) included 3 lambs where the oesophagus was transacted and anastomosed without excision of an oesophageal segment. Group B included 6 lambs where a wedge of the oesophagus was excised and a Silastic tube fixed to the inner mucosa. The oesophageal edges were in contact on one side. In group C (3 lambs), a 2-cm cylinder of the oesophagus was excised, a Silastic tube was fixed to the inner mucosa and a gap of 2 cm was left between the oesophageal edges. The lambs were sacrificed at two weeks to five weeks postoperatively.

There was no mortality, no anastomotic leakage and no wound infection in any of the lambs. The oesphageal edges grew and bridged the gap and formed a continuous tube. Histological examination showed new muscle fibres underneath the new mucosa. All lambs with Silastic tubes gained weight. Two lambs developed moderate to severe stricture.

The present study demonstrated the possibility of oesophageal growth over a Silastic tube to form a continuous oesophagus. Histological examination confirmed oesophageal growth and not healing through fibrous tissue. Further studies are needed to evaluate the technique in the thoracic oesophagus with long-term follow-up.