Gastric tube interposition as an esophageal substitute: comparative evaluation with gastric tube in continuity and gastric transposition.
OBJECTIVE
The aim of this study was to evaluate growth, hematologic and biochemical parameters, and histopathology after gastric tube interposition, gastric tube in continuity with or without posterior fundoplication, and gastric transposition in an experimental model.


METHODS
Twenty-two postweaned, 28-day-old piglets were divided randomly into four groups: group 1 (n = 9) gastric tube interposition, group 2 (n = 4) gastric tube in continuity, group 3 (n = 5) gastric tube in continuity with posterior fundoplication, and group (n = 4) gastric transposition. The postoperative assessment included weekly measurement of weight, documentation of clinical symptoms, and deglutition difficulties. Hemoglobin, serum ferritin, albumin, globulins, total proteins, and red cell folate were measured. The pigs were killed and histopathologic assessment was made following a maximum observation period of 149 days.


RESULTS
The four pigs with gastric transposition died within 96 hours postoperatively of respiratory embarrassment. The salient clinical features and histology are summarised. The salient clinical complications observed in the four groups were as follows. Group 1: vomiting (11%), minor leak (22%), and stricture (11%). There was no impairment of deglutition and the growth was normal. Group 2: vomiting (100%), excessive salivation (100%), and episodes of cyanosis (100%). Growth was impaired but there was no impairment of deglutition. Group 3: vomiting (80%), excessive salivation (80%), and episodes of cyanosis (20%). There was no impairment in deglutition or growth. Group 4: vomiting (100%), episodes of cyanosis (100%), and respiratory embarrassment (100%). Pigs in group 4 had to be sacrificed on day 3 or 4 postoperatively because of severe respiratory embarrassment, cyanosis, and presumed gastroesophageal reflux. At autopsy the anastomoses were intact, with no evidence of leak. The stomach and esophagus had good vascularity. Histopathology demonstrated esophagitis in 11% of the specimens in group 1, 100% of those in group 2, and 60% of those in group 3. Submucosal fibrosis was seen in 56% of group 1, 100% of group 2, and 80% of group 3. Hyperkeratosis was observed in 75% of group 2 and 40% of group 3 specimens.


CONCLUSIONS
Gastric tube interposition in this animal model was associated with improved growth, fewer clinical complications, and fewer histopathologic changes than gastric tube in continuity with or without posterior fundoplication or gastric transposition.
Wessex Regional Centre for Pediatric Surgery, Southampton General Hospital, England.
M
M
Samuel
D M
DM
Burge
D000714:Anastomosis, Surgical; D000818:Animals; D004195:Disease Models, Animal; D004933:Esophageal Atresia / Q000601:surgery; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D011183:Postoperative Complications; D013270:Stomach / Q000601:surgery* / Q000637:transplantation; D013528:Surgical Staplers; D013552:Swine