Abstract
Introduction Traction procedures are useful to preserve the child's own esophagus in long-gap
forms of esophageal atresia. To date, it remains unclear what suture size or position
of the traction sutures is optimal to account for differences in anatomy and to reduce
the risk of traction sutures being torn out of the esophageal tissue.
Materials and Methods Explanted porcine esophagi (from swine aged 100–120 days and weighing 100–120 kg)
were divided at the carinal level. Traction sutures were either placed circumferentially
or only in the dorsal wall and the breaking strength—circumferential disruption of
the muscular layer—was measured. Suture size (USP 4–0 vs. 5–0) was also evaluated
in a similar way.
Results Neither traction suture position did not influence breaking strengths between circumferentially
placed traction sutures or those exclusively placed in the dorsal esophageal wall
(Δ = 0.47 N, 95% confidence interval: −2.83 to 3.76 N, p = 0.771, n = 11 per group) nor differing suture sizes of USP 4–0 and USP 5–0 (Δ = 1.46 N, 95%
confidence interval: −3.2 to 0.28 N, p = 0.0946, n = 9 per group) affected breaking strengths.
Conclusion Suture size and suture positioning do not affect mechanical stability in Foker's
procedure and therefore can be adapted as needed according to patient's anatomy and
size.
Keywords
esophageal - suturing - traction procedure - esophageal surgery
