Surgical Reconstruction of Partial Circumferential Esophageal Defect in the Dog

Abstract

Partial circumferential reconstruction of the cervical esophagus was evaluated in the dog. An esophageal defect 5.85 +/- 1.15 cm in length involving one-half of the circumference was repaired by direct closure (group I), using longus colli muscle patch grafts (group II), and using grafts of longus colli muscle lined with buccal mucosa (group III). The incidence of leakage, fistula formation, luminal stricture, peristalsis disturbance, lining loss, the quality of surface restoration, bursting strength, and wound healing were evaluated. No fistula formation or leakage was observed in any animal. Direct closure of the defect was easier to perform, led to less inflammatory reaction, and resulted in the highest bursting strength. However, this method was associated with luminal stricture and swallowing difficulties. The longus colli muscle patch grafts (group II) were associated with a slight to moderate luminal stricture, but had more inflammatory reaction and graft surface area contraction (62%) compared to group III. The longus colli muscle lined with buccal mucosa caused no stricture and slight surface area contraction (8%). Mucosal grafts remained viable and no lining loss was observed. Despite the loss of peristalsis at the level of the graft in 25% of the group III dogs, no clinical signs or swallowing difficulties were observed.

Reconstruction of the oesophagus using pedicle diaphragm and omentum flaps in a dog: a case report

“…However, there was no stricture formation in our case, which was confirmed by oesophagram performed six months after surgery. The incidence of oesophageal stricture formation after reconstruction with muscle and omentum flap is lower than that in the primary closure of the oesophagus (Zhang and Yang, 1987;Bouayad et al, 1992). This might be related to the abundant elastic fibres of the diaphragm and rich vascular omentum.…”

“…Therefore, it was necessary to reconstruct the oesophageal defect without causing excessive wound tension, which is considered to be an important etiologic factor for wound dehiscence. For oesophageal reconstruction, various muscle flaps such as diaphragm, pleural, and intercostal muscle flap have been studied as a means of repairing an oesophageal defect and perforation depending on the location of the injury (Bouayad et al, 1992;Jones and Ginsberg, 1992;Richardson, 2005). The diaphragm muscle flap has been used to repair caudal oesophageal perforation in humans (Richardson, 2005) and animals (Paulo et al, 2007).…”

Oesophageal dysmotility in a dog following surgical correction of an oesophageal perforation

“…Surgical management is advised when lesions are severe to allow for exploration and repair 5,11,15 . There are a number of surgical techniques devised with no single one entirely satisfactory for repairing partial circumferential oesophageal defects 19 . The canine oesophagus is composed solely of striated muscle with a segmental blood supply 13,20 .…”

“…The procedure is subjective, and subtle disorders of the swallow reflex can be difficult to detect 21 . Unfortunately, oesophageal manometry was not available to further assess pressure profiles generated by peristalsis 19,21 . The use of iodinated contrast media is preferred due to the potential for barium to leak into the mediastinum exacerbating mediastinitis 11,15 .…”

“…In a 1992 experimental study 19 of surgical reconstruction of partial circumferential oesophageal defects in the cervical oesophagus, oesophageal peristalsis was lost at the operative site; however peristalsis remained normal cranial and caudal to the lesion. In this study, after 4 weeks peristalsis had returned but was decreased at the surgical site until 4 months post‐operatively when it had returned to normal.…”