Esophagectomy and Substitution of the Thoracic Esophagus. Experimental Study in Dogs
C.E.M. Santos1; S.C. Rahal1; D.C. Damasceno2
The use of the whole stomach or gastric tubes as substitutes for the esophagus are common procedures in human patients, but there are few clinical reports of their use in small animals, especially involving a large extension of the intrathoracic esophagus. The present study evaluated a technique to remove the thoracic esophagus without thoracotomy and two methods for thoracic esophageal replacement in dogs, ex vivo, aiming at the treatment of diseases associated with this species. Twenty-one dogs that had died or been euthanatized were used. The dogs were randomly divided into three groups of seven animals each in order to evaluate: G1--total thoracic esophagectomy by the inverting stripping method; G2--total thoracic esophagectomy and esophageal substitution using the whole stomach; G3--total thoracic esophagectomy and esophageal substitution using fundus rotation gastroplasty according to the method of Büchler. Heineke-Mikulicz pyloroplasty was performed in both G2 and G3. After esophageal resection in G1, the integrity of the intrathoracic route was evaluated by endoscopy and tested with 1% methylene blue solution. Visceral pleural rupture was observed in all animals, especially in the caudal third portion. However, this intrathoracic route made it possible to bring both esophagus substitutes (G2 and G3) to be anastomosed to the cut end of the cervical esophagus. Thoracic esophageal substitution using the whole stomach showed less anastomotic tension and was less technically demanding than the fundus rotation gastroplasty method. The ex- vivo results support further studies to validate the techniques in clinical cases.