Esophageal End-To-End Anastomosis:Reduction of Anastomotic Tension by Circular Myotomy

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Abstract
The effect on anastomotic tension of circular myotomy of the esophagus was studied in 25 piglets by direct measurements and in terms of primary anastomotic healing and survival. Operations were performed either in the cervical or in the thoracic region and consisted of end-to-end anastomosis after resection of a determined length of esophagus and circular myotomy. The maximal length of resection involved 43 % of the cervical and 36% of the thoracic esophagus, respectively. Following myotomy, a 66% average reduction of anastomotic tension occurred regardless of the site or the extent of esophageal resection. Postoperatively the animals were unrestricted, had free access to food and received no adjunctive therapy. The mortality was nil. The average observation period in the entire series was 11 weeks. The anastomoses healed invariably without evidence of leak. In 10 animals the anastomotic width was normal, while in 15 it was decreased. The muscular manchette distal to myotomy remained intact. There were no signs of functional or organic obstruction at the site of muscular interruption. On the basis of our results we believe that clinical trial of this method is warranted. Esophageal atresia, post-anasto-motic or caustic strictures and congenital short esophagus are the clinical applications suggested.

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