End-to-end oesophageal anastomosis: an experimental study in the rat

To study the effects of suture material, calibre and tension on the end-to-end oesophageal anastomosis, the cervical oesophagus of the rat was resected for 2.5 mm, 7.5 mm and 12.5 mm respectively in three groups of 60 rats each. End-to-end anastomosis was performed with either 6/0 silk, 6/0 polypropylene or 9/0 polypropylene sutures. There was no postoperative leakage. Mortality was mainly due to hair bolus obstruction at the site of anastomosis. There was no difference in mortality and anastomotic stenosis between groups with different resection lengths. Within each group, however, mortality and anastomotic stenosis were significantly higher in the subgroup of rats with 6/0 silk suture than that in the subgroup with 6/0 polypropylene sutures, which also had significantly higher mortality and anastomotic stenosis than the subgroup with 9/0 polypropylene sutures. Histological examination of the stenosed anastomosis showed disruption of muscle layers and submucosal thickening. It is concluded that the use of fine calibre sutures of biologically inert material would be preferred for the end-to-end anastomosis of the oesophagus.