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Eur J Pediatr Surg 2021; 31(02): 177-181
DOI: 10.1055/s-0040-1710025
Original Article

A Continuous Suture Anastomosis Outperforms a Simple Interrupted Suture Anastomosis in Esophageal Elongation

Christina Oetzmann von Sochaczewski 
1   Department of Pediatric Surgery, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Germany
,
Evangelos Tagkalos
2   Department of General, Visceral and Transplant Surgery, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Germany
,
Andreas Lindner
1   Department of Pediatric Surgery, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Germany
,
Hauke Lang
2   Department of General, Visceral and Transplant Surgery, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Germany
,
Axel Heimann
3   Institute for Neurosurgical Pathophysiology, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Germany
,
Oliver J. Muensterer
1   Department of Pediatric Surgery, Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Germany
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Abstract

Introduction Long-gap esophageal atresia represents a distinct entity among the esophageal atresia spectrum. In many patients, achieving a reasonable anastomosis depends on some millimeters of tissue. We aimed to determine what effect the suturing technique would have on esophageal ex vivo elongation as it may determine the strength of a primary anastomosis.

Materials and Methods In an analysis of porcine esophagi from animals for slaughter (100–120 days old with a weight of 100–120 kg), we determined esophageal length gain of simple continuous and simple interrupted suture anastomoses subjected to linear traction until linear breaking strength was reached. Statistical power of 80% was ensured based on an a priori power analysis using five specimens per group in a separate exploratory experiment.

Results The simple continuous suture anastomosis in 15 porcine esophagi ( = 4.47 cm, 95% confidence interval: 4.08–4.74 cm) outperformed the simple interrupted suture anastomosis in another 15 esophagi ( = 3.03 cm, 95% confidence interval: 2.59–3.43 cm) in length gain (Δ = 1.44 cm, 95% confidence interval: 0.87–2.01 cm, p < 0.0001).

Conclusion Simple continuous anastomoses achieved higher length gain compared with simple interrupted suture anastomoses. This effect warrants an experimental assessment in vivo to assess its potential merits for clinical applicability.

Keywords

esophageal biomechanics - surgical suturing - esophageal surgery - swine


Publication History

Received: 30 November 2019

Accepted: 22 March 2020

Article published online:
18 May 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Bairdain S, Zurakowski D, Vargas SO. et al. Long-gap esophageal atresia is a unique entity within the esophageal atresia defect spectrum. Neonatology 2017; 111 (02) 140-144
    CrossrefPubMedGoogle Scholar
  • 2 Foker JE, Linden BC, Boyle Jr EM, Marquardt C. Development of a true primary repair for the full spectrum of esophageal atresia. Ann Surg 1997; 226 (04) 533-541
    CrossrefPubMedGoogle Scholar
  • 3 Foker JE, Kendall TC, Catton K, Khan KM. A flexible approach to achieve a true primary repair for all infants with esophageal atresia. Semin Pediatr Surg 2005; 14 (01) 8-15
    CrossrefPubMedGoogle Scholar
  • 4 Michaud L, Guimber D, Sfeir R. et al. Sténose anastomotique après traitement chirurgical de l'atrésie de l'œsophage : fréquence, facteurs de risque et efficacité des dilatations œsophagiennes. Arch Pediatr 2001; 8 (03) 268-274
    CrossrefPubMedGoogle Scholar
  • 5 Schneider A, Blanc S, Bonnard A. et al. Results from the French National Esophageal Atresia register: one-year outcome. Orphanet J Rare Dis 2014; 9 (01) 206
    CrossrefPubMedGoogle Scholar
  • 6 Sillén U, Hagberg S, Rubenson A, Werkmäster K. Management of esophageal atresia: review of 16 years' experience. J Pediatr Surg 1988; 23 (09) 805-809
    CrossrefPubMedGoogle Scholar
  • 7 McKinnon LJ, Kosloske AM. Prediction and prevention of anastomotic complications of esophageal atresia and tracheoesophageal fistula. J Pediatr Surg 1990; 25 (07) 778-781
    CrossrefPubMedGoogle Scholar
  • 8 Urschel JD, Scott PG, Williams HTG. The effect of mechanical stress on soft and hard tissue repair; a review. Br J Plast Surg 1988; 41 (02) 182-186
    CrossrefPubMedGoogle Scholar
  • 9 Morse BC, Simpson JP, Jones YR, Johnson BL, Knott BM, Kotrady JA. Determination of independent predictive factors for anastomotic leak: analysis of 682 intestinal anastomoses. Am J Surg 2013; 206 (06) 950-955
    CrossrefPubMedGoogle Scholar
  • 10 Oetzmann von Sochaczewski C, Tagkalos E, Lindner A. et al. Esophageal biomechanics revisited: a tale of tenacity, anastomoses, and suture bite lengths in swine. Ann Thorac Surg 2019; 107 (06) 1670-1677
    CrossrefPubMedGoogle Scholar
  • 11 Oetzmann von Sochaczewski C, Tagkalos E, Lindner A, Lang H, Heimann A, Muensterer OJ. Technical aspects in esophageal lengthening: an investigation of traction procedures and suturing techniques in swine. Eur J Pediatr Surg 2019; 29 (05) 481-484
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Behrend M, Kluge E, Schüttler W, Klempnauer J. Breaking strength of native and sutured trachea. An experimental study on sheep trachea. Eur Surg Res 2001; 33 (04) 255-263
    CrossrefPubMedGoogle Scholar
  • 13 Yang W, Fung TC, Chian KS, Chong CK. Directional, regional, and layer variations of mechanical properties of esophageal tissue and its interpretation using a structure-based constitutive model. J Biomech Eng 2006; 128 (03) 409-418
    CrossrefPubMedGoogle Scholar
  • 14 Carniel EL, Gramigna V, Fontanella CG. et al. Characterization of the anisotropic mechanical behaviour of colonic tissues: experimental activity and constitutive formulation. Exp Physiol 2014; 99 (05) 759-771
    CrossrefPubMedGoogle Scholar
  • 15 Carniel EL, Frigo A, Fontanella CG. et al. A biomechanical approach to the analysis of methods and procedures of bariatric surgery. J Biomech 2017; 56: 32-41
    CrossrefPubMedGoogle Scholar
  • 16 Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39 (02) 175-191
    CrossrefPubMedGoogle Scholar
  • 17 Efron B. Better bootstrap confidence intervals. J Am Stat Assoc 1987; 82 (397) 171-185
    CrossrefPubMedGoogle Scholar
  • 18 Hesterberg TC. What teachers should know about the bootstrap: resampling in the undergraduate statistics curriculum. Am Stat 2015; 69 (04) 371-386
    CrossrefPubMedGoogle Scholar
  • 19 Mangiafico S. . Rcompanion: Functions to Support Extension Education Program Evaluation; 2018 . Accessed September 5, 2018 at: https://CRAN.R-project.org/package=rcompanion
    PubMed
  • 20 Livaditis A, Jönsson L. The piglet in experimental pediatric surgery. Z Versuchstierkd 1979; 21 (02) 78-82
    PubMedGoogle Scholar
  • 21 Mortell A, Montedonico S, Puri P. Animal models in pediatric surgery. Pediatr Surg Int 2006; 22 (02) 111-128
    CrossrefPubMedGoogle Scholar
  • 22 Sullins VF, Traum PK, French SW, Wu BM, Dunn JCY, Lee SL. A novel method of esophageal lengthening in a large animal model of long gap esophageal atresia. J Pediatr Surg 2015; 50 (06) 928-932
    CrossrefPubMedGoogle Scholar
  • 23 Dibbern CB, Rose M, Ellebæk MB, Qvist N. The effect of intramural botulinum toxin injections on the elongation of the piglet oesophagus is time dependent. Eur J Pediatr Surg 2017; 27 (01) 56-60
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Glenn IC, Bruns NE, Schomisch SJ, Ponsky TA. Creation of an esophageal atresia animal model using a bifurcated esophagus to maintain digestive tract continuity. J Laparoendosc Adv Surg Tech A 2017; 27 (10) 1079-1084
    CrossrefPubMedGoogle Scholar
  • 25 Bruns NE, Glenn IC, Craner DR, Schomisch SJ, Harrison MR, Ponsky TA. Magnetic compression anastomosis (magnamosis) in a porcine esophagus: proof of concept for potential application in esophageal atresia. J Pediatr Surg 2019; 54 (03) 429-433
    CrossrefPubMedGoogle Scholar
  • 26 Oetzmann von Sochaczewski C, Heimann A, Linder A, Kempski O, Muensterer OJ. Esophageal blood flow may not be directly influenced by anastomotic tension: an exploratory laser Doppler study in swine. Eur J Pediatr Surg 2019; 29 (06) 516-520
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Oetzmann von Sochaczewski C, Lindner A, Heimann A. et al. Beyond magnamosis: a method to test sutureless esophageal anastomotic devices in living swine by creating an esophageal bypass loop for natural oral nutrition. J Laparoendosc Adv Surg Tech A 2019; 29 (06) 852-855
    CrossrefPubMedGoogle Scholar
  • 28 Muensterer OJ, Sterlin A, Oetzmann von Sochaczewski C. et al. An experimental study on magnetic esophageal compression anastomosis in piglets. J Pediatr Surg 2020; 55 (03) 425-432
    CrossrefPubMedGoogle Scholar
  • 29 Jensen T, Wanczyk H, Sharma I, Mitchell A, Sayej WN, Finck C. Polyurethane scaffolds seeded with autologous cells can regenerate long esophageal gaps: an esophageal atresia treatment model. J Pediatr Surg 2019; 54 (09) 1744-1754
    CrossrefPubMedGoogle Scholar
  • 30 Baumgart J, Deigendesch N, Lindner A. et al. Using multidimensional scaling in model choice for congenital oesophageal atresia: similarity analysis of human autopsy organ weights with those from a comparative assessment of Aachen Minipig and Pietrain piglets. Lab Anim 2020; 54 (06) 576-587
    CrossrefPubMedGoogle Scholar
  • 31 Takada Y, Kent G, Filler RM. Circular myotomy and esophageal length and safe esophageal anastomosis: an experimental study. J Pediatr Surg 1981; 16 (03) 343-348
    CrossrefPubMedGoogle Scholar
  • 32 Christensen MB, Oberg K, Wolchok JC. Tensile properties of the rectal and sigmoid colon: a comparative analysis of human and porcine tissue. Springerplus 2015; 4 (01) 142
    CrossrefPubMedGoogle Scholar
  • 33 Yuan Y, Wang K-N, Chen L-Q. Esophageal anastomosis. Dis Esophagus 2015; 28 (02) 127-137
    CrossrefPubMedGoogle Scholar
  • 34 Grimminger PP, van der Horst S, Ruurda JP, van Det M, Morel P, van Hillegersberg R. Surgical robotics for esophageal cancer. Ann N Y Acad Sci 2018; 1434 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 35 Hollands CM, Dixey LN. Robotic-assisted esophagoesophagostomy. J Pediatr Surg 2002; 37 (07) 983-985
    CrossrefPubMedGoogle Scholar
  • 36 Lorincz A, Langenburg SE, Knight CG, Gidell K, Rabah R, Klein MD. Robotically assisted esophago-esophagostomy in newborn pigs. J Pediatr Surg 2004; 39 (09) 1386-1389
    CrossrefPubMedGoogle Scholar
  • 37 Holler A-S, Schwind M, Poplawska K, Muensterer OJ. Thoracoscopic tracheoesophageal N-fistula repair using a 5.8-mm miniature stapler for fistula division. Eur J Pediatr Surg Rep 2017; 5 (01) e55-e56
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Zani A, Eaton S, Hoellwarth ME. et al. International survey on the management of esophageal atresia. Eur J Pediatr Surg 2014; 24 (01) 3-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Reusens H, Matthyssens L, Vercauteren C, van Renterghem K. ; Belgian Association of Paediatric Surgery (BELAPS). Multicentre survey on the current surgical management of oesophageal atresia in Belgium and Luxembourg. J Pediatr Surg 2017; 52 (02) 239-246
    CrossrefPubMedGoogle Scholar
  • 40 Tagkalos E, Lindner A, Gruber G. et al. Using simple interrupted suture anastomoses may impair translatability of experimental rodent oesophageal surgery. Acta Chir Belg 2020; 120 (05) 310-314
    CrossrefPubMedGoogle Scholar
  • 41 Myers NA. Oesophageal atresia: the epitome of modern surgery. Ann R Coll Surg Engl 1974; 54 (06) 277-287
    PubMedGoogle Scholar