Segmental Neogenesis of the Dog Esophagus Utilizing a Biodegradable Polymer Framework

Abstract

This study evaluated the ability of biodegradable implants fabricated from polymers and co-polymers of polylactic acid (PLA) and polyglycolic acid (PGA) to induce regeneration of surgically created defects in the dog esophagus. The study utilized 12 mongrel dogs that had a 5 cm segment of the esophagus removed. Implants were fabricated by spray casting the polymers on a spinning Teflon mandril. The defects were repaired by suturing the biodegradable implants to the proximal and distal ends of the esophagus. Ten of the dogs were sacrificed from 3 days to 8 weeks after surgery while 1 of the dogs died after 3 years and 1 dog was sacrificed 4 years after graft placement. Endoscopic and histologic examination of the grafts 3 days after placement showed minimal inflammatory response and an apparent seal between the esophagus and implant at the suture lines. Two weeks after surgery a fibrous connective tissue sheath, continuous with the proximal and distal segments of the esophagus, could be seen surrounding the graft. One month after placement, the implants were partially degraded leaving a connective tissue repair continuous with the proximal and distal ends of the esophagus. The repair area was lined with epithelium and enabled the dogs to drink freely and eat semisolid foods. In conclusion, it has been shown that it is possible to fabricate a biodegradable implant which can stimulate regeneration of a hollow organ and which is compatible with long term survival.