Replacement of the Cervical and Thoracic Esophagus in Dog Using Free Jejunal Autografts

Abstract

Free revascularized jejunal grafts based on a single branch of the mesenteric artery and vein were selected and used for replacement of the cervical esophagus in 20 dogs. The graft pedicle was transplanted to the left external jugular vein and the internal carotid artery using end-to-side microvascular anastomoses. The procedure was successful in all the dogs; however, five dogs had fistula formation that healed spontaneously. A similar jejunal autograft was used to replace the thoracic esophagus in 20 dogs. The recipient vessels were the internal thoracic artery and vein. Only four dogs survived. Thirteen dogs could not survive because of infection resulting from leakage of esophageal content from the esophagojejunal anastomoses into the thoracic cavity. Only two dogs had infarcted jejunal grafts. The four surviving dogs could swallow liquid and semisolid food but they never returned to solid food because of difficulties with swallowing. Graft survival was confirmed with endoscopy and arterial angiography. Narrowed jejunal graft lumen was apparent with contrast radiography and endoscopy. The jejunal grafts kept peristalsis and contracted in coordinated fashion with the proximal esophagus. At necropsy, wound healing was evaluated using bursting strength and bursting circular wall tension. Although slight adhesion and fibrosis around the grafts as well as slight inflammatory reaction around the suture material were observed, the jejunal grafts were grossly and microscopically normal. All esophagojejunal anastomoses healed and the jejunal mucosa looked normal.

Reconstruction of a partial esophageal defect using tunica vaginalis and buccal mucosa autograft: an experimental study in mongrel dogs

“…Histopathological examination of the grafted site of this dog showed richness in inflammatory cells, dense fibrous collagen, and granulation tissue. Leakage may be attributed to mucosal dehiscence [ 60 ] or minor stenosis of the rebuilt esophageal segment [ 13 ]. In accordance with our findings, other studies recorded early leakage starting between the third and fifth postoperative days, with spontaneous closure of the fistula occurring between the 10th and 15th postoperative days [ 13 , 22 ].…”

“…Leakage may be attributed to mucosal dehiscence [ 60 ] or minor stenosis of the rebuilt esophageal segment [ 13 ]. In accordance with our findings, other studies recorded early leakage starting between the third and fifth postoperative days, with spontaneous closure of the fistula occurring between the 10th and 15th postoperative days [ 13 , 22 ]. These results were consistent with the histological and IHC findings, which showed that the original mesothelium of the TV graft and stratified squamous epithelium of the BM graft regenerated successfully to the natural epithelium of the esophagus, resulting in the absence of leakage.…”

“…The esophagus has limited mobility because it is connected proximally to the pharynx and distally to the diaphragm and stomach [ 46 ]. Many autografts are used for esophageal reconstruction, including muscle [ 12 , 61 , 70 ], skin tubes [ 52 ], stomach wall [ 21 ], jejunum, and colon [ 13 , 26 , 62 ]. However, autografts from vital organs put the animal under the consequences of surgical intervention in healthy organs or unnecessary laparotomy [ 36 ].…”