Technical considerations of experimental esophageal anastomosis

Following transection and anastomosis of the intrathoracic esophagus, the effects of rotating the esophageal ends, lumen-widening procedures, microsurgical technique and traction sutures were studied in 8 series of 10 piglets each. The results were evaluated with contrast-medium X-ray examination and macrophotography. The different procedures were compared with single-layer end-to-end anastomosis with 6/0 silk. Anastomosis with 10/0 supramid withstood the tension in the intrathoracically stressed esophageal anastomosis, but gave no advantages. Rotating of the ends of the transected esophagus showed no significant differences. Widening the anastomotic lumen with longitudinal incisions did not result in a wider lumen. Further extension of the anastomotic circumference with a Z-shaping of the mucosa did not reduce stricture formation. Traction sutures between the esophageal wall and perivertebral fascia gave a significantly wider anastomotic lumen. There was no correlation between stricture, and the amount of granuloma, submucous leakage, or degree of histologic change.