Linear esophagotomy reinforcement with nonvascularized omental autograft (NOA)

Esophagotomy is commonly complicated by dehiscence and leakage. Recent studies provided evidence that omentopexy may reinforce the esophageal suture line and decrease the rate of postoperative complications. The use of nonvascularized omental autograft (NOA) to strengthen the linear esophagotomy wound is novel and this was derived from its successful use in other location by Saifzadeh et al. The goal of the current study was to examine the role of NOA on the healing quality of primary esophagotomy wound. Linear esophageal incisions of 8-10 mm were made at the cervical esophagus in 20 New Zealand white rabbits, which were assigned to two identical groups (10 rabbits in each group). The incisions were sutured in both groups but additionally covered by NOA in Group Pi. Twenty-eight days after the operations, the experimental animals were killed, and identical segments of the esophagus with the esophagotomy line at the center were removed. The intact specimens were evaluated for bursting pressure and histologic appearance. Bursting pressure was higher in Group Pi. Microscopic evaluation in Group Pi rabbits revealed the participation of NOA in esophagotomy healing, tough complete epithelial regeneration, marked neovascularization, and muscular regeneration and overgrowth. This study showed demonstrable benefit from the use of NOA in reinforcement of cervical esophagotomy. To the best of our knowledge, this is the first report of strengthening of the esophageal suture line with the transplantation of NOA.