Esophageal Biomechanics Revisited: A Tale of Tenacity, Anastomoses, and Suture Bite Lengths in Swine

Sochaczewski, Christina Oetzmann von; Lindner, Andreas; Lang, Hauke; Heimann, Axel; Schröder, Arne; Grimminger, Peter; Muensterer, Oliver J.

doi:10.1016/j.athoracsur.2018.12.009

Cited by 15 publications

(20 citation statements)

References 34 publications

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“…The data on the resistance to traction forces of several anastomotic techniques is available elsewhere. 10 In this experiment, we measured the elongation of the specimens during application of traction forces until failure of the anastomoses for simple continuous and simple interrupted suture anastomoses. Our methodology has been described in detail before.…”

Section: Methodsmentioning

confidence: 99%

“…Our methodology has been described in detail before. 10,11 In brief, esophagi of swine (Sus scrofa domestica, weighing 100-120 kg at an age of 100-120 days) were obtained from a local abattoir (Färber, Alzey, Germany), stored in a humid atmosphere, and processed to the end of the experiment within 5 hours of slaughtering as described previously for the investigation of biomechanical tissue properties. [11][12][13][14][15] Esophagi were freed from its surrounding tissue, mounted in a motorized horizontal test stand (Sauter THM, Sauter, Balingen, Germany), and subjected to linear traction until visible disruption of the circumferential muscular layer occurred.…”

Section: Methodsmentioning

confidence: 99%

“…A video of the endpoint has been published before to make this abstract description more accessible for the reader by its visual depiction. 10 All anastomoses were constructed by the same surgeon (C.O.) at 13 cm distal to the upper esophageal sphincter using USP 4-0 polydioxanone (Ethicon, Norderstedt, Germany) sutures.…”

Section: Methodsmentioning

confidence: 99%

“…Initial length of all esophagi was around 26 cm as depicted elsewhere. 10 Suture bite length was 8 mm to the cut surface, with a 5-mm lateral advancement (►Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…This summed up to a relatively uniform number of 10 stitches per anastomosis. 10 All endpoints were verified by a second researcher (A.L. ).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Initial length of all esophagi was around 26 cm as depicted elsewhere. 10 Suture bite length was 8 mm to the cut surface, with a 5-mm lateral advancement (►Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…This summed up to a relatively uniform number of 10 stitches per anastomosis. 10 All endpoints were verified by a second researcher (A.L. ).…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2020

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A novel piglet model of esophageal stricture following variable segmental esophageal resection and re‐anastomosis

von Sochaczewski,

Riedesel,

Lindner

et al. 2024

Anim Models and Exp Med

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BackgroundEsophageal strictures following esophageal atresia repair are a source of significant morbidity. To test new therapeutic approaches, we designed a piglet model of esophageal stricture by resecting variable lengths of esophagus with subsequent re‐anastomosis. This study describes the model and validates its physiologic impact by blinded analysis of the weight gains of the piglets.MethodsA total of 24 two‐week old Pietrain piglets had esophageal resections performed, ranging from 0 to 5 cm, with the goal of inducing postoperative esophageal strictures. Postoperative body‐weights were evaluated by repeated analysis of variance followed by pairwise group‐comparisons based on estimated marginal means. In addition, body weight was modeled by linear‐mixed model regression. Different resection lengths were compared. The esophagi were evaluated postmortem for stricture.ResultsOf 24 operated piglets, 23 reached the endpoint, and 90% developed an esophageal stricture that was radiologically visible in a contrast study, as well as appreciable macroscopically in the necropsy. We found differences in pre‐ and postoperative body weights for all piglets (F (1, 18) = 298.54, p < 0.001), but no differences between resection lengths (F (4, 18) = 0.36, p = 0.837).ConclusionOur model of postoperative esophageal stricture offers the opportunity to investigate potential treatments for strictures associated with esophageal atresia, since it reliably induces strictures and results in minimal loss of animals. The similar body weight gain in all groups indicates that stricture is mainly the result of esophageal resection and re‐anastomosis, regardless of the length of the resected segment.

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Extrathoracic Lengthening (Kimura Technique)

Lenz

König

Sterlin

et al. 2021

Esophageal Preservation and Replacement in Children

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Esophageal Biomechanics Revisited: A Tale of Tenacity, Anastomoses, and Suture Bite Lengths in Swine

Cited by 15 publications

References 34 publications

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

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

A novel piglet model of esophageal stricture following variable segmental esophageal resection and re‐anastomosis

Extrathoracic Lengthening (Kimura Technique)

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