Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Sections
    • Collections
  • Podcasts
  • Author Info
    • Overview for authors
    • Publication fees
    • Forms
    • Editorial policies
    • Submit a manuscript
    • Open access
  • Careers
  • Alerts
    • Email alerts
    • RSS
  • About
    • General information
    • Staff
    • Editorial Board
    • Contact
  • CMAJ JOURNALS
    • CMAJ
    • CMAJ Open
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CJS
  • CMAJ JOURNALS
    • CMAJ
    • CMAJ Open
    • JAMC
    • JPN
CJS

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Sections
    • Collections
  • Podcasts
  • Author Info
    • Overview for authors
    • Publication fees
    • Forms
    • Editorial policies
    • Submit a manuscript
    • Open access
  • Careers
  • Alerts
    • Email alerts
    • RSS
  • About
    • General information
    • Staff
    • Editorial Board
    • Contact
  • Subscribe to our alerts
  • RSS feeds
  • Follow CJS on Twitter
Original Article

Effect of pyloric drainage on the healing of esophagogastric anastomoses in rats

Yingjie Cui, John D. Urschel and Nicholas J. Petrelli
Can J Surg December 01, 2000 43 (6) 456-458;
Yingjie Cui
*Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
John D. Urschel
†Department of Surgery, McMaster University, Hamilton, Ont.
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nicholas J. Petrelli
*Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Abstract

Background and objectives: Esophagogastric anastomotic leaks complicate 5% to 20% of esophagectomies for esophageal cancer and are responsible for approximately one-third of perioperative deaths. Poor gastric emptying is a predisposing factor for anastomotic leakage. An animal experiment was used to test the hypothesis that a pyloric drainage procedure (pyloromyotomy) would have a positive effect on esophagogastric anastomotic healing.

Methods: In 40 rats single-layer esophagogastric anastomoses were constructed with interrupted 7-0 polypropylene sutures. A pyloromyotomy was done in the experimental group (20 rats) but not in the control group (20 rats). Rats were sacrificed on the 7th postoperative day and their anastomoses were excised, mounted in a tensiometer, and distracted at 10 mm/min to measure breaking strength. After that, the hydroxyproline concentration (an indicator of wound collagen) of the anastomotic tissue was measured.

Results: There were no anastomotic leaks. The mean (and standard deviation) breaking strength of the esophagogastric anastomosis was 3.96 (1.14) N in the pyloromyotomy rats and 4.11 (0.75) N in the control rats (p = 0.64). The mean (and SD) hydroxyproline concentration in esophagogastric anastomotic tissue was 368.6 (31.5) nmol/mg in the pyloromyotomy rats and 376.6 (31.3) nmol/mg in the control rats (p = 0.77).

Conclusion: Pyloric drainage (pyloromyotomy) did not have any effect on esophagogastric anastomotic wound healing in this rat model.

Esophagogastric anastomotic leaks complicate 5% to 20% of esophagectomies for esophageal cancer and are responsible for approximately one-third of perioperative deaths after esophagectomy.1 Poor gastric emptying can be a predisposing factor for anastomotic leakage.2 Randomized controlled clinical trials have produced conflicting results regarding the overall value of pyloric drainage, and there is little information on the effect of pyloric drainage on esophagogastric anastomotic leakage. 3–5 An animal experiment was done to test the hypothesis that a pyloric drainage procedure (pyloromyotomy) would have a beneficial effect on esophagogastric anastomotic healing.

Methods

Forty female Sprague–Dawley rats (Harlan, Indianapolis, Ind.), weighing 200 to 250 g, were housed 3 to a cage in conventional suspension cages and allowed food and water up to 4 hours before operation. They were anesthetized with intraperitoneal pentobarbital sodium (50 mg/kg) (Abbott Laboratories, Abbott Park, Ill.). With the use of sterile technique, a 4-cm midline laparotomy was done. The distal esophagus was mobilized, and its anterior aspect was incised transversely at a point 5 mm proximal to the gastroesophageal junction. A gastrotomy 4-mm long was made in the glandular portion of the proximal anterior stomach. A side-to-side single-layer esophagogastric anastomosis was constructed with interrupted 7-0 polypropylene (Ethicon, Somerville, NJ) sutures, as previously described.6

In the experimental group (20 rats), the pylorus muscle (a distinct anatomic entity in the rat) was divided without penetrating the gastric or duodenal mucosa. This was not done in the 20 control rats. The linea alba was closed with a continuous 5-0 suture Polyglactin 910 (Ethicon). Skin was closed with the same suture by a running horizontal mattress technique. Animals were allowed free access to food and water after recovery from anesthesia.

Rats were killed on postoperative day 7 with an intraperitoneal injection of pentobarbital sodium (120 mg/kg). Four rats died or were sacrificed early because of aspiration pneumonia (1 in the control group and 3 in the experimental group). This left 36 rats for wound-healing studies. Anastomoses were excised, mounted in an Instron mini-44 tensiometer (Instron, Canton, Mass.) and distracted at 10 mm/min to measure breaking strength (in newtons). After that, anastomotic tissue (wound plus 1 mm of tissue on each side) was excised and the hydroxyproline concentration of the tissue (an indicator of wound collagen formation) was measured.7

Measured data are presented as means (and standard deviations). Differences in breaking strength and hydroxyproline concentration were analyzed by the 2-tailed Student’s t-test. A probability value of less than 0.05 was taken to be significant. The study was approved by the Institutional Animal Care and Use Committee and conducted in accordance with the National Research Council’s guide for the care and use of laboratory animals.8

Results

There were no anastomotic leaks. Esophagogastric anastomotic breaking strength was 3.96 (1.14) N in the experimental group of rats and 4.11 (0.75) N in the control group (p = 0.64). Hydroxyproline concentration in the esophagogastric tissue was 368.6 (31.5) nmol/mg in the experimental group and 376.6 (31.3) nmol/mg in the control group (p = 0.77).

Discussion

Most experienced esophageal surgeons recommend initial nasogastric tube decompression after esophagectomy. 1,2 Early postoperative gastric distension unduly stresses the anastomosis and may worsen occult ischemia of the gastroplasty tube.1,2,9 However, many cervical esophagogastric anastomotic leaks occur late (after day 7) in the postoperative course, at a time when nasogastric tubes have been removed. 1 Poor gastric emptying can occur if a drainage procedure (pyloromyotomy or pyloroplasty) is not done at the time of esophagectomy.3,5 Therefore, the presence or absence of a pyloric drainage procedure may influence the occurrence of esophagogastric anastomotic leaks.

We have previously noticed a tendency for gastric stasis in our rat esophagogastric anastomotic experiments.6,7 Stasis occurs despite seemingly adequate preservation of the vagal nerves. This laboratory observation, along with the clinical information already outlined, led us to hypothesize that a pyloromyotomy would have a positive effect on the healing of esophagogastric anastomoses.

Our experiment failed to show any effect of pyloric drainage on esophagogastric anastomotic wound healing as evaluated by measurement of anastomotic breaking strength and hydroxyproline concentration. These parameters of wound repair are commonly used in laboratory studies even though the important issue in clinical gastrointestinal surgery is anastomotic leakage.10 Nevertheless, the lack of any anastomotic leaks in this experiment is problematic. The side-to-side esophagogastric anastomoses in this rat model may be too secure.6 We developed the side-to-side anastomotic technique because of difficulties with end-to-end esophagogastric anastomoses in rats; early stricture formation led to profound postoperative weight loss in animals in some of our previous experiments.7 Other investigators have had similar experiences with end-to-end anastomoses in rats.11 These difficulties have prompted most investigators to use large animals for esophagogastric anastomotic experiments. 6 Finally, the timing of anastomotic assessment (postoperative day 7) may have had some impact on the experimental results. However, previous studies in our laboratory have shown that this is an appropriate time to make comparisons of anastomotic wound healing.12–14

This study of the effect of pyloric drainage on esophagogastric anastomotic wound healing in rats showed no difference in anastomotic strength, hydroxyproline concentration or number of leaks. Despite the limitations in study design, the results suggest that pyloric drainage simply had no effect on esophagogastric anastomotic healing.

  • Accepted October 18, 1999.

References

  1. ↵
    1. Urschel JD
    . Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 1995; 169:634–40.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Dewar L,
    2. Gelfand G,
    3. Finley RJ,
    4. Evans K,
    5. Inculet R,
    6. Nelems B
    . Factors affecting cervical anastomotic leak and stricture formation following esophagogastrectomy and gastric tube interposition. Am J Surg 1992;163:484–9.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Fok M,
    2. Cheng SW,
    3. Wong J
    . Pyloroplasty versus no drainage in gastric replacement of the esophagus. Am J Surg 1991;162:447–52.
    OpenUrlCrossRefPubMed
    1. Zieren HU,
    2. Muller JM,
    3. Jacobi CA,
    4. Pichlmaier H
    . Should a pyloroplasty be carried out in stomach transposition after subtotal esophagectomy with esophago-gastric anastomosis at the neck? A prospective randomized study. Chirurg 1995;66:319–25.
    OpenUrlPubMed
  4. ↵
    1. Mannell A,
    2. McKnight A,
    3. Esser JD
    . Role of pyloroplasty in the retrosternal stomach: results of a prospective, randomized, controlled trial. Br J Surg 1990;77:57–9.
    OpenUrlPubMed
  5. ↵
    1. Cui Y,
    2. Urschel JD,
    3. Petrelli NJ
    . Esophagogastric anastomoses in rats — an experimental model. J Invest Surg 1999; 12:295–8.
    OpenUrlPubMed
  6. ↵
    1. Urschel JD,
    2. Antkowiak JG,
    3. DeLacure MD,
    4. Takita H
    . Ischemic conditioning (delay phenomenon) improves esophagogastric anastomotic wound healing in the rat. J Surg Oncol 1997;66:254–6.
    OpenUrlCrossRefPubMed
  7. ↵
    National Research Council. Guide for the care and use of laboratory animals. Washington: National Academy Press; 1996.
  8. ↵
    1. Urschel JD,
    2. Antkowiak JG,
    3. Takita H
    . Gastric distention exacerbates ischemia in a rodent model of partial gastric devascularization. Am J Med Sci 1997; 314:284–6.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Hendriks T,
    2. Mastbloom WJ
    . Healing of experimental intestinal anastomoses. Parameters for repair. Dis Colon Rectum 1990;33:891–901.
    OpenUrlCrossRefPubMed
  10. ↵
    1. Levi A,
    2. Ramadan E,
    3. Gelber E,
    4. Koren R,
    5. Chaimoff C,
    6. Kyzer S
    . Healing of the esophageal suture line: Does it differ from the rest of the alimentary tract? Isr J Med Sci 1996:32:1313–6.
    OpenUrlPubMed
  11. ↵
    1. Urschel JD,
    2. Takita H,
    3. Antkowiak JG
    . The effect of ischemic conditioning on gastric wound healing in the rat: implications for esophageal replacement with stomach. J Cardiovasc Surg (Torino) 1997;38:535–8.
    OpenUrlPubMed
    1. Urschel JD
    . The effect of ischaemia on anastomotic wound healing in the rat stomach. Med Sci Res 1996;24:35–6.
    OpenUrl
  12. ↵
    1. Cui Y,
    2. Urschel JD
    . Esophagogastric anastomotic wound healing in rats. Dis Esophagus 1999;12:149–51.
    OpenUrlPubMed
PreviousNext
Back to top

In this issue

Canadian Journal of Surgery: 43 (6)
Can J Surg
Vol. 43, Issue 6
1 Dec 2000
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CJS.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Effect of pyloric drainage on the healing of esophagogastric anastomoses in rats
(Your Name) has sent you a message from CJS
(Your Name) thought you would like to see the CJS web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Effect of pyloric drainage on the healing of esophagogastric anastomoses in rats
Yingjie Cui, John D. Urschel, Nicholas J. Petrelli
Can J Surg Dec 2000, 43 (6) 456-458;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Effect of pyloric drainage on the healing of esophagogastric anastomoses in rats
Yingjie Cui, John D. Urschel, Nicholas J. Petrelli
Can J Surg Dec 2000, 43 (6) 456-458;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Alerts
  • RSS

Authors & Reviewers

  • Overview for Authors
  • Publication Fees
  • Forms
  • Editorial Policies
  • Submit a manuscript

About

  • General Information
  • Staff
  • Editorial Board
  • Contact Us
  • Advertising
  • Reprints
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. Print ISSN 0008-428X; Online ISSN 1488-2310.

All editorial matter in CJS represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected].

CMA Civility, Accessibility, Privacy

 

 

Powered by HighWire