Self-expanding removable plastic stents for the protection of surgical anastomoses after esophageal replacement in a porcine model.
BACKGROUND
Esophageal replacement by biological graft is associated with a high risk of anastomotic leak-related mediastinitis.


OBJECTIVE
To determine whether a self-expanding plastic stent can help avoid anastomotic leak after full-thickness replacement of the esophagus in a porcine model.


METHODS
Experimental feasibility study in a porcine model.


METHODS
Twelve pigs were analyzed in the study.


METHODS
Replacement of a 2-cm-long segment of the cervical esophagus by an aortic allograft was performed in 12 pigs, with 6 pigs used as graft donors. Animals were divided into 2 groups depending on whether a self-expanding removable plastic stent protecting the 2 aortoesophageal anastomoses was inserted (n = 7) or not (n = 5), and were allowed to eat 24 hours postoperatively.


METHODS
The relative occurrence of mediastinitis caused by anastomotic leakage in stented and nonstented groups was assessed; endoscopic evaluation and histological analysis of the graft area were performed 1 month after esophageal replacement.


RESULTS
All animals (n = 5) without stent insertion died of anastomotic leakage within 20 days of surgery. Two of the 7 stented animals died at day 2, and 5 survived 1 month in good clinical condition. Two stent migrations were noted. Stent extraction was followed by the development of a fibrous stricture.


CONCLUSIONS
The use of a self-expanding plastic stent seems to allow leak-free healing after circumferential replacement of the esophagus by a biological graft in a porcine model.
Le Baleur
Yann
Y
Endoscopy Unit, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris, France.
Gaujoux
Sébastien
S
Bruneval
Patrick
P
Lambert
Benoît
B
Larghero
Jérome
J
Cattan
Pierre
P
Prat
Frédéric
F
D057868:Anastomotic Leak / Q000517:prevention & control*; D000818:Animals; D001011:Aorta / Q000637:transplantation*; D004947:Esophagus / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005548:Foreign-Body Migration / Q000453:epidemiology; D008297:Male; D008480:Mediastinitis / Q000209:etiology*; D023421:Models, Animal; D011474:Prosthesis Design; D015607:Stents; D013552:Swine; D014184:Transplantation, Homologous