Esophagogastric anastomotic wound healing in rats

Abstract

Esophagectomy with esophagogastric anastomosis is commonly complicated by anastomotic dehiscence. Although this is a major problem in clinical esophageal surgery, laboratory investigation of esophagogastric anastomotic wound healing has been hampered by the lack of a practical rodent model. Problems with aspiration pneumonia and anastomotic strictures hindered our previous studies in the rat. Other researchers have turned to large animal experiments, or used various upper gastrointestinal pseudoanastomotic techniques in rodents. None of these approaches has proved satisfactory. We developed a technique of side-to-side esophagogastric anastomosis in the rat, and then studied normal esophagogastric anastomotic healing in this model. Anastomoses were performed in 24 rats. Anastomotic breaking strength and hydroxyproline concentration were measured 1 and 2 weeks after surgery. Anastomotic breaking strength was 3.78 +/- 1.18 N at 1 week and 4.83 +/- 0.91 N after 2 weeks (p < 0.03). Anastomotic tissue hydroxyproline concentration was 370.6 +/- 31.2 nmol/mg at 1 week and 462.1 +/- 69.7 nmol/mg after 2 weeks (p < 0.001). Many of the problems encountered in esophagogastric anastomotic studies in the rat have been overcome using this new model.

Intraoperative laser fluorescence angiography in colorectal surgery: a noninvasive analysis to reduce the rate of anastomotic leakage

“…Thirty-five studies between 2002 and 2009 investigated the incidence of anastomotic leakage and reported rates between 1.2% and 19.2% with a mean incidence of 6.9%. As individual risk factors such as age [13][14][15], gender [16][17][18], nutritional status [19][20][21], and malignant disease [22] are beyond the influence of the surgeon, focus has to turn to factors such as technique and localization of anastomosis [23], anastomosis under tension [24], and tissue perfusion of the anastomotic region [25][26][27][28]. It is surprising that the technical means to visualize tissue perfusion has not been routinely applied in colorectal surgery until now.…”

Esophagogastric anastomosis in rats: Improved healing by BPC 157 and L-arginine, aggravated by L-NAME

“…It was highly successful against a perilous and mortal course even when it had to be markedly aggravated by L-NAME application. Namely, as observed before, rats undergoing esophagogastric anastomosis are severely affected[29,30]. They exhibited failed anastomosis healing[30,31], but they also presented with progressive esophagitis and gastric lesions, leakage, failed pressure within the anastomosis site that was markedly below values noted in the rat’s lower esophageal sphincter, a dysfunctional pyloric sphincter, weight loss, a short-life, and inescapable lethal outcomes.…”

“…As a result, these standard peptide growth factors[26,28] only support the particular perilous course of the esophagogastric anastomosis and show little improvement in rats[29,30]. On the other hand, these combined BPC 157 effects may be more useful for both anastomosis healing and sphincter function rescue[10-14,17,18,20-25].…”

The Effect of Anchoring Suture on the Anastomotic Blood Flow in a Rat Model of Human Esophagojejunostomy

“…The incidence of anastomotic leakage from the esophagogastrostomy increased when the anastomotic tension increased. Anastomotic tension was a key factor that caused esophagogastric anastomotic leaks [4]. However, there is currently no effective method to reduce the anastomotic tension of esophagojejunostomy except reoperation, so many trials to reduce the complications of esophageal anastomosis have been performed: omentopexy, ischemic conditioning, local decontamination, the use of growth factor, and additional vascular anastomosis.…”