Effect of pyloric drainage on the healing of esophagogastric anastomoses in rats.
OBJECTIVE
Esophagogastric anastomotic leaks complicate 5% to 20% of esophagectomies for esophageal cancer and are responsible for approximately one-third of perioperative deaths. Poor gastric emptying is a predisposing factor for anastomotic leakage. An animal experiment was used to test the hypothesis that a pyloric drainage procedure (pyloromyotomy) would have a positive effect on esophagogastric anastomotic healing.


METHODS
In 40 rats single-layer esophagogastric anastomoses were constructed with interrupted 7-0 polypropylene sutures. A pyloromyotomy was done in the experimental group (20 rats) but not in the control group (20 rats). Rats were sacrificed on the 7th postoperative day and their anastomoses were excised, mounted in a tensiometer, and distracted at 10 mm/min to measure breaking strength. After that, the hydroxyproline concentration (an indicator of wound collagen) of the anastomotic tissue was measured.


RESULTS
There were no anastomotic leaks. The mean (and standard deviation) breaking strength of the esophagogastric anastomosis was 3.96 (1.14) N in the pyloromyotomy rats and 4.11 (0.75) N in the control rats (p = 0.64). The mean (and SD) hydroxyproline concentration in esophagogastric anastomotic tissue was 368.6 (31.5) nmol/mg in the pyloromyotomy rats and 376.6 (31.3) nmol/mg in the control rats (p = 0.77).


CONCLUSIONS
Pyloric drainage (pyloromyotomy) did not have any effect on esophagogastric anastomotic wound healing in this rat model.
Cui
Y
Y
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.
Urschel
J D
JD
Petrelli
N J
NJ
D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D000818:Animals; D004195:Disease Models, Animal; D004322:Drainage / Q000379:methods*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005750:Gastric Juice; D005774:Gastrostomy / Q000379:methods*; D006909:Hydroxyproline / Q000032:analysis; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011708:Pylorus / Q000601:surgery*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013270:Stomach / Q000601:surgery*; D013536:Suture Techniques; D013718:Tensile Strength; D014945:Wound Healing
D006909:Hydroxyproline