Esophageal anastomotic failure: an experimental study.
BACKGROUND
Postsurgical complications in patients with esophageal atresia have remained unchanged during the last three decades. This study was aimed at investigating certain risk factors for small-sized esophageal anastomosis and to assess the probable relationship between esophageal length and body weight in rabbit.


METHODS
Six groups of 10 adult rabbits were subjected to section or 1-cm segmental resection of thoracic esophagus followed by end-to-end anastomosis. Approximation strength of esophageal ends was measured. Three different suture materials were used, and three different surgeons carried out procedures. Observed morbidity was recorded, as well as leakage or stenosis frequency in suture line. Esophageal length and body weight of nonresected rabbits were measured.


RESULTS
Fifteen leakages were observed in suture line; there were no differences in relative risk between groups with and without resection, or in ratio of this complication among surgeons; nonetheless, a greater number of leakages (p < 0.05) was observed at higher tension. There were no differences in magnitude of stenosis among surgeons, tension degree, or suture material used. Quadratic association was found between length of thoracic esophagus and body weight in nonresected rabbits.


CONCLUSIONS
Rabbit esophagus is a suitable model to assess early surgical complications but not for late complications. Among three assessed factors, increased tension in patients with segmental deficit was the most significant factor in development of anastomotic leakage. Existence of nonlineal correlation between esophageal length and body weight in rabbit showed that resection of 1 cm of esophagus represented a different weight-dependent segmental deficit, which increased as weight decreased.
Laboratorio de Cirugía Experimental, Edificio de Investigación Dr. Joaquin Cravioto, Instituto Nacional de Pediatría, Secretaría de Salud, Mexico City, Mexico. fvadiaz@prodigy.net.mx
Fernando
F
Villegas-Alvarez
Jaime
J
Olvera-Durán
Edmundo
E
Rodríguez-Aranda
Arturo
A
Carmona-Mancilla
Rosa Ma
RM
Vigueras-Villaseñor
Ignacio
I
Méndez-Ramírez
D000714:Anastomosis, Surgical / Q000009:adverse effects; D000818:Animals; D001835:Body Weight; D002648:Child; D004933:Esophageal Atresia / Q000601:surgery; D004947:Esophagus / Q000033:anatomy & histology / Q000601:surgery*; D006801:Humans; D008297:Male; D011817:Rabbits; D011897:Random Allocation; D012307:Risk Factors; D013529:Surgical Wound Dehiscence; D015996:Survival Rate; D013537:Sutures; D013718:Tensile Strength; D017211:Treatment Failure