Comparison of Pressure Resistances of Different Esophagogastric Anastomosis Techniques: An Ex Vivo Ovine Model Study

Abstract

Background: Current anastomosis techniques including conventional esophageal (CEAT) and region expanding anastomosis techniques (REAT) in esophagus cancer surgeries have high mortality and morbidity rates, which underlines the lack of a golden standard method. Anastomosis techniques are one of responsible factors for stricture formation. In this regard, the study conducted on ex vivo ovine tissues was aimed to compare pressure resistances of different anastomosis techniques in term of stricture formation. Methods: Thirty-five esophagus and gastric samples from 35 male lambs aged 12 months were used ex vivo for the study. Samples were divided into 5 groups according to anastomosis techniques including Hand-Made Sutured Technique (HM), Circular Stapler Sutured Technique (CS), Reinforced Circular Stapler Sutured Technique (rCS), Modified Plus “+” Incision Technique (mP+IT), and Modified Arrow-Bow Hand-Made Sutured Technique (mabHM). The intraluminal pressure resistance of the CEAT (e.g. the HM, CS and rCS) and REAT (e.g. the mP+IT and mabHM) were recorded. Results: The pressures of different incision techniques from the highest to the lowest were found as follows: the rCS (114.71±3.77 cm H2O) > the CS (95.43±3.45 cm H2O) > the HM (84.14±3.67cm H2O) > the mabHM (79.71±2.87 cm H2O) > the mP+IT (77.14±6.23 cm H2O) (p < 0.001). Except the comparison of the HM versus the mabHM (p=0.558), and the mP+IT versus the mabHM, the other techniques differ statistically significantly from each other. Conclusion: In our study, the durability of anastomoses using CEAT was found to be higher and compatible with the literature. Although in vivo live animal studies are necessary, REAT can be safely used to prevent the development of stricture, which is the second most common complication of esophagogastric anastomoses. Our findings suggest that the CEAT especially the rCS can be safely administered to prevent leakage.