An experimental assessment of esophageal anastomotic integrity

A series of experiments was designed to establish the role of proximal diversion and perioperative antibiotics in primary healing of experimental esophageal anastomoses designed to stimulate the clinical leak and death rate seen in patients treated for carcinoma of the esophagus. Thirty-four cats underwent partial thoracic esophagectomy with end-to-end anastomosis. Seventeen cats were randomized to complementary proximal esophageal diversion. Postoperative mortality was 38 per cent. The over-all rate of anastomotic leakage was 18 per cent, with 83 per cent of these cats dying as a result of this complication. Proximal esophageal diversion had no demonstrable role in the prevention of anastomotic dehiscence or subsequent mortality. In 22 of 34 cats, systemic perioperative antibiotics were administered. Administration of perioperative antibiotics decreased anastomotic leak significantly, p less than 0.05, and lowered mortality, p less than 0.001, with or without proximal esophageal diversion.