Long-Gap Esophageal Atresia - How to Gain Length: An Experimental Study.

Abstract

This experimental study was carried out on rabbits in order to evaluate the usefulness of circular myotomies, in bridging the esophageal gap. Thirty two rabbits were divided into 2 groups, each having 16 rabbits. Rabbits of first group underwent resections of 1cm, 2cm, 3cm and 4 cm of esophagus in subgroups of 4 rabbits each. Single circular myotomy of upper esophageal segment was followed by end to end anastomosis. Rabbits of second group had resection of similar lengths in each subgroups but double circular myotomies were performed followed by end to end esophageal anastomosis. There was no post-operative anastomotic leak with resection of upto 2cm segments in case of single circular myotomy whereas 25% of animals with 3cm resection and 50% of 4cm resections showed leak after single circular myotomy. With double circular myotomies there was no leak upto 3 cm resection of esophagus whereas resection of 4 cm showed 25% leak. The authors conclude that upto 2 cm esophageal gap can be easily bridged with single circular myotomy whereas gaps of 3-4 cm should be repaired by double circular myotomies.