Farklı Özofagogastrik Anastomoz Tekniklerinin Basınç Dirençlerinin Karşılaştırılması: Bir Ex Vivo Küçükbaş Hayvan Modeli Çalışması

Year 2023, Volume: 16 Issue: 1, 1 - 8, 30.04.2023

Duygu Mergan İliklerden Ümit Haluk İliklerden Ozan Okyay İbrahim Özalp Orhan Beger Serhat Binici Burhan Beger Caner Kayıkcı

https://doi.org/10.52976/vansaglik.1040145

Abstract

Giriş: Özofagus kanseri ameliyatlarında konvansiyonel özofagus (CEAT) ve bölge genişletici anastomoz teknikleri (REAT) gibi mevcut anastomoz tekniklerinin yüksek mortalite ve morbidite oranlarına sahip olması, altın standart bir yöntemin eksikliğinin altını çizmektedir. Anastomoz teknikleri, darlık oluşumundan sorumlu faktörlerden biridir. Bu bağlamda, ex vivo koyun dokuları üzerinde yapılan çalışmada, farklı anastomoz tekniklerinin basınç dirençlerinin darlık oluşumu açısından karşılaştırılması amaçlanmıştır.
Materyal-Metod: Çalışma için 12 aylık 35 erkek kuzudan alınan otuz beş yemek borusu ve mide örneği ex vivo olarak kullanıldı. Örnekler anastomoz tekniklerine göre El Yapımı Dikiş Tekniği (HM), Circular Stapler Sütürlü Tekniği (CS), Reinforced Circular Stapler Sütürlü Tekniği (rCS), Modifiye Plus “+” İnsizyon Tekniği (mP+IT), ve Modifiye Ok-Yay El Yapımı Dikişli Tekniği (mabHM). CEAT (örn. HM, CS ve rCS) ve REAT'in (örn. mP+IT ve mabHM) intraluminal basınç direnci kaydedildi.
Bulgular: En yüksekten en düşüğe farklı kesi tekniklerinin basınçları şu şekilde bulundu: rCS (114.71±3.77 cm H2O) > CS (95.43±3.45 cm H2O) > HM (84.14±3.67cm H2O) > mabHM (79.71±2.87 cm H2O) > mP+IT (77.14±6.23 cm H2O) (p < 0.001). HM ile mabHM'nin (p=0,558) ve mP+IT ile mabHM'nin karşılaştırılması dışında, diğer teknikler birbirinden istatistiksel olarak önemli ölçüde farklıdır.
Sonuç: Çalışmamızda CEAT kullanılan anastomozların dayanıklılığı daha yüksek ve literatürle uyumlu bulundu. İn vivo canlı hayvan çalışmaları gerekli olmakla birlikte, özofagogastrik anastomozların en sık görülen ikinci komplikasyonu olan darlık gelişimini önlemek için REAT güvenle kullanılabilir. Bulgularımız, sızıntıyı önlemek için CEAT'ın özellikle rCS'nin güvenli bir şekilde uygulanabileceğini göstermektedir.

Keywords

esophagogastric anastomosis, stricture, surgical techniques, esophagus, stomach

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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.

Keywords

Esophagogastric Anastomosis, Stricture, Surgical Techniques, Esophagus, Stomach

Project Number

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References

• 1) Bradshaw CJ, Sloan K, Morandi A, Lakshminarayanan B, Cox SG, Millar AJ, Lakhoo K. Outcomes of Esophageal Replacement: Gastric Pull-Up and Colonic Interposition Procedures. Eur J Pediatr Surg 2018;28:22-29.
• 2) Bolca C, Dumitrescu M, Fotache G, Stoica R, Cadar G, Cordoș I. Comparative Study of Early Postoperative Complications: Thoracic Anastomosis vs Cervical Anastomosis–in Esophageal Replacement with Gastric Graft. Chirurgia (Bucur) 2018;113: 95-100.
• 3) Shuangba H, Jingwu S, Yinfeng W, Yanming H, Qiuping L, Xianguang L, Zhenkun Y. Complication following gastric pull-up reconstruction for advanced hypopharyngeal or cervical esophageal carcinoma: a 20-year review in a Chinese institute. Am J Otolaryngol 2011;32:275-278.
• 4) Briel JW, Tamhankar AP, Hagen JA, DeMeester SR, Johansson J, Choustoulakis E, DeMeester TR. Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 2004;198:536-541.
• 5) Melek M, Cobanoglu U. A new technique in primary repair of congenital esophageal atresia preventing anastomotic stricture formation and describing the opening condition of blind pouch: plus (‘‘+’') incision. Gastroenterol Res Pract 2011;2011:527323.
• 6) Sharma AK, Wakhlu A. Simple technique for proximal pouch mobilization and circular myotomy in cases of esophageal atresia with tracheoesophageal fistula. J Pediatr Surg 1980;29:1402-1403.
• 7) Singh SJ, Shun A. A new technique of anastomosis to avoid stricture formation in oesophageal atresia. Pediatr Surg Int 2001;17:575-577.
• 8) El-Malt M, Ceelen W, van den Broecke C, Cuvelier C, Van Belle S, De Neve W, de Hemptinne B, Pattyn P. Healing of experimental colonic anastomoses effects of combined preoperative high-dose radiotherapy and intraperitoneal 5-flourouracil. Int J Cancer 2001;96:297–304.
• 9) Raman V, Moodie KL, Ofoche OO, Kaiser LR, Erkmen CP. Endoscopy after esophagectomy: Safety demonstrated in a porcine model. J Thorac Cardiovasc Surg 2017;154(3):1152-1158.
• 10) Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J. Analysis of reduced death and complication rates after esophageal resection. Ann Surg 2001;233:338-344.
• 11) Verstegen MH, Bouwense SA, van Workum F, ten Broek R, Siersema PD, Rovers M, Rosman C. Management of intrathoracic and cervical anastomotic leakage after esophagectomy for esophageal cancer: a systematic review. World J Emerg Surg 2019;14:17.
• 12) Koruda MJ, Rolandelli RH. Experimental studies on the healing of colonic anastomoses. J Surg Res 1990;48:504-515. 13) Hendriks T, Mastboom WJB. Healing of experimental intestinal anastomoses. Parameters for repair. Dis Colon Rectum 1990;33:891-901.
• 14) Levi A, Ramadan E, Gelber E, Koren R, Chaimo C, Kyzer S. Healing of the esophageal suture line: does it differ from the rest of the alimentary tract? Isr J Med Sci 1996;32:1313-1316.
• 15) Urschel JD, Takita H, Antkowiak JG. The effect of ischemic conditioning on gastric wound healing in the rat: implications for esophageal replacement with stomach. J Cardiovasc Surg 1997;38:535-538.
• 16) Hsu HK, Hsu WH, Huang MH. Prospective study of using fibrin glue to prevent leak from esophagogastric anastomosis. J Surg Assoc ROC 1992;25:1248-1252.
• 17) Spitz L. Oesophageal atresia. Orphanet J Rare Dis 2007;2:24.
• 18) Cui Y, Urschel JD. Comparison of anastomotic suturing techniques in the rat esophagus. J Cardiovasc Surg 1999;40:613-614.
• 19) Chunwei F, Qingzeng N, Jianliang L. Cervical esophagogastric anastomosis with a new stapler in the surgery of esophageal carcinoma. Eur J Cardiothorac Surg 2005;28:291-295.
• 20) Peracchia A, Bardini R, Ruol A. Esophagovisceral anastomotic leak: a prospective statistical study of predisposing factors. J Thorac Cardiovasc Surg 1988;95:685-691.
• 21) Law S, Fok M, Chu KM, Wong J. Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg 1997;226:169-173.
• 22) Ein S, Ashcraft KW. Discussion: long-term results following repair of esophageal atresia by end-to-side anastomosis and ligation of the tracheoesophageal fistula. J Pediatr Surg 1981;16:983-988.
• 23) Gough MH. Esophageal atresia: use of an anterior flap in the difficult anastomosis. J Pediatr Surg 1980;15:310-311.
• 24) Sulamaa M, Gripenberg I, Alvenainen EK. Prognosis and treatment of congenital atresia of the oesophagus. Acta Chirurgica Scandinavia 1951;102:141-157.
• 25) de Carvalho JL, Maynard J, Hadley GP. An improved technique for in situ esophageal myotomy and proximal pouch mobilization in patients with esophageal atresia. J Pediatr Surg 1989;24:872-873.
• 26) Lindahl H. Esophageal atresia: A simple technical detail aiding the mobilization and circular myotomy of the proximal segment. J Pediatr Surg 1987;22:113-114.
• 27) Aumar M, Rousseau V, Bonnard A, Sfeir R, Gelas T, Boubnova J, Lamireau T. DOZ047.01: Risk factors for anastomotic strictures in the first year after esophageal atresia repair: data from a prospective multicentric cohort. 2019, https://doi.org/10.1093/dote/doz047.01.
• 28) Yurtçu M, Findik S, Yurtçu ME, Baba ZF. Investigation of Histopathologic Changes in Pelviureteral Anastomoses after Local Application of Fibrinogen and Thrombin. SOA Clin Med Cases Rep Rev 2018;4:2.