Esophageal Clamp Anastomosis: An Experimental Study in Piglets

Abstract

A clamp for esophageal end-to-end anastomosis has been designed and tested experimentally in 33 piglets. Eighteen anastomoses involved the entire esophageal wall, and 15 the mucosal layer alone. The results were evaluated on the basis of clinical, cineradiographic, gross and microscopic examinations. The width of the anastomoses was assessed under standardized conditions.

The experience gained from the present series indicates that the sutureless technique provides a fairly tight seal for the prevention of leak. Irrespective of the type of clamp anastomosis, healing invariably occurred with anastomotic stricture.

The onset of the stricturing process was early and rapidly progressive.

Cineradiographic studies provided conclusive evidence of stricture and demonstrated concurrent motility disturbances in the distal esophagus.

Inflation and radiography of the specimen under a standard degree of filling consistently showed reduction of lumen and elasticity at the anastomotic line.

Histologic evidence demonstrated extensive fibrous involvement of the anastomosis and confirmed the occurrence of mucosal destruction in early killings.

An account is given of factors which might be related to the development of strictures. Mechanical compression from the clamp leading to mucosal destruction or vascular impairment appears to be the most likely.

Continued experimental work is required for clarification of the factors responsible for stricture. Clinical use of this clamp technique cannot be recommended at present.