Biomechanics of esophageal elongation with traction sutures on experimental animal model

Abstract

Esophageal elongation is one of the methods of long gap esophageal atresia treatment. The aim of the study was to determine the best type of traction suture for esophageal lengthening on an animal model. White Pekin Duck’s esophagi were used as a model (fresh-frozen and thawed). The esophagus was cut in half, then both ends were sutured together and extended on a tensiometer. Tested sutures involved simple suture, suture aided by a single or double clip, and suture aided by pledget (10 samples each). Constant and 2 methods of intermittent traction were also compared. The histological study showed similarities between duck’s and newborn’s esophagus. The highest maximal force was achieved with pledget suture (F = 8.59 N ± 1.45 N), then with double clip (F = 5.74 N ± 1.29 N) and the lowest with single suture (F = 3.80 N ± 0.54 N) (p < 0.001). Pledget suture also allowed for the greatest elongation (p < 0.01). Intermittent traction results in better elongation at the same breaking strength as constant traction (p < 0.05) if traction is maintained during breaks. Reinforced sutures (pledget or double clip) should be taken into consideration in internal traction. When performing traction sutures, it is worth step by step carefully tightening the sliding knot in short periods before its final binding.

Long-gap esophageal atresia: management, most frequent complications, and expert recommendations – review of literature

“…study conducted on an animal model (white Pekin Duck esophagus) showed that when using this technique pledget sutures or a double clip should be used, because the maximal force of traction without tissue disruption and the greatest elongation of esophageal pouches were then achieved [30]. Furthermore, this study showed that gradual tightening of the sliding knot in short periods (intermittent traction) enables tissue adaptation, reduces the risk of ruptures, and should be therefore recommended.…”

“…This is a novel procedure which enables the elongation of the proximal and distal esophagus directly towards each other using sliding knots. Fixation on the thoracic wall is therefore not necessary [11,24,30] . Toczewski's et al…”

Extrathoracic esophageal elongation with Foker technique in patients with Type-A esophageal atresia. A case series

“…This is because they help prevent dislodging of the traction suture, which can be a problem during esophageal elongation. [8] In our patients, enteral feeding was initiated on the 5th day post esophageal anastomosis via the OG tube. At follow-up, all three patients were able to tolerate oral intake.…”

Not All Porcine Intestinal Segments Are Equal in Terms of Breaking Force, but None Were Associated to Allometric Parameters

“…For the cecum, the representative section was directly adjacent to the aboral part of the ileo-cecal valve; for the colon, it was 20 cm aboral to the ileocecal valve; and for the rectum, it was 10 cm oral to the anus. The excised section was then mounted into a motorized test stand (Sauter THM500N, Kern & Sohn, Balingen, Germany) and subjected to linearly increasing traction forces (Figure 1), which advanced at the standard rate of 10 mm per minute used in such experiments [46][47][48][49]. Traction forces were gauged using a tensiometer (FL100, Kern & Sohn, Balingen, Germany) until the muscular layer was disrupted and the mucosal layer was still visible.…”