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Guo J, Xu Y, Huang C, Wang M, Zhang F, Liu Z, Li Z, Lv H, Tian Z. Oblique conformal anastomosis decreased the risks of cervical anastomotic leakage after totally minimally invasive esophagectomy. Asian J Surg 2024:S1015-9584(24)00568-2. [PMID: 38604851 DOI: 10.1016/j.asjsur.2024.03.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 12/08/2023] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVE To investigate the effectiveness of the original oblique conformal anastomosis presented in this research in reducing the incidence of cervical anastomotic leak after performing totally minimally invasive esophagectomy (TMIE). METHODS The esophagus and stomach of 27 fresh pigs, termed the esophagogastric model, were used to simulate human esophagogastric organs for this study's in vitro experimental objectives. Nine esophagogastric models of similar weight were divided into three groups. Esophagogastrostomy with circular-stapled end-to-side anastomosis was performed. A tension gauge was used to pull the anastomosis, and the tension at which anastomotic leakage occurred was recorded. Furthermore, a retrospective assessment of 539 patients who underwent TMIE was conducted to analyze the influencing factors of cervical anastomotic leakage. RESULTS Experiments on the esophagogastric models showed a higher fracture strength of oblique conformal anastomosis than that of conventional anastomosis (F2,18 = 40.86, P < 0.05), which was associated with a lower incidence of cervical anastomotic leakage (X2 = 9.0260, P = 0.0027). Retrospective analysis of 539 esophageal cancer patients who underwent TMIE showed that in contrast to conventional anastomosis, oblique conformal anastomosis was an independent protective factor against cervical anastomotic leakage (P = 0.0462, OR = 0.5872, 95% CI = 0.3497-0.9993). CONCLUSION Oblique conformation anastomosis was stronger and involved a more prominent reduced risk of cervical anastomotic leakage than conventional anastomosis after TMIE.
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Affiliation(s)
- Jinyang Guo
- Emergency Department, The Affiliated Hospital of Chengde Medical University, China
| | - Yanzhao Xu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, China
| | - Chao Huang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, China
| | - Mingbo Wang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, China
| | - Fan Zhang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, China
| | - Zhao Liu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, China
| | - Zhenhua Li
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, China
| | - Huilai Lv
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, China
| | - Ziqiang Tian
- Fourth Hospital of Hebei Medical University, China.
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Ishikawa M, Tomita H, Ito Y, Tsukizaki A, Abe K, Shimotakahara A, Shimojima N, Hirobe S. Analysis of gap length as a predictor of surgical outcomes in esophageal atresia with distal fistula: a single center experience. Pediatr Surg Int 2024; 40:99. [PMID: 38581456 DOI: 10.1007/s00383-024-05678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/08/2024]
Abstract
PURPOSE Long-gap esophageal atresia (LGEA) is still a challenge for pediatric surgery. No consensus exists as to what constitutes a long gap, and few studies have investigated the maximum gap length safely repairable by primary anastomosis. Based on surgical outcomes at a single institution, we aimed to determine the gap length in LGEA with a high risk of complications. METHODS The medical records of 51, consecutive patients with esophageal atresia (EA) with primary repair in the early neonatal period between 2001 and 2021 were retrospectively reviewed. Three, major complications were found in the surgical outcomes: (1) anastomotic leakage, (2) esophageal stricture requiring dilatation, and (3) GERD requiring fundoplication. The predictive power of the postsurgical complications was assessed using receiver operating characteristic analysis, and the area under the curve (AUC) and the cutoff value with a specificity of > 90% were calculated. RESULTS Sixteen patients (31.4%) experienced a complication. The AUC of gap length was0.90 (p < 0.001), and the gap length cutoff value was ≥ 2.0 cm for predicting any complication (sensitivity: 62.5%, specificity: 91.4%). CONCLUSION A gap length ≥ 2.0 cm was considered as defining LGEA and was associated with an extremely high complication rate after primary repair.
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Affiliation(s)
- Miki Ishikawa
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Hirofumi Tomita
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Yoshifumi Ito
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Ayano Tsukizaki
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Kiyotomo Abe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Akihiro Shimotakahara
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Naoki Shimojima
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Seiichi Hirobe
- Department of Surgery, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan
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Oetzmann von Sochaczewski C, Deigendesch N, Lindner A, Baumgart J, Schröder A, Heimann A, Muensterer OJ. Comparing Aachen Minipigs and Pietrain Piglets as Models of Experimental Pediatric Urology to Human Reference Data. Eur Surg Res 2020; 61:95-100. [PMID: 33161395 DOI: 10.1159/000511399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Swine had special roles in the development of minimally invasive procedures to treat vesicoureteral reflux, and minipigs have been gaining ground in recent years in experimental pediatric urology as they combine small size with less vulnerable adult physiology, but their suitability as a model has never been assessed. We therefore compared a landrace piglet with a juvenile minipig to elucidate comparability. METHODS We evaluated five 3-week old Pietrain piglets and five 3-month old Aachen Minipigs as representatives of landrace and minipig models based on their expected bodyweight being similar to a newborn human. We compared renal weight, volume - via the ellipsoid formula - and ureteral length. In addition, we calculated porcine renal function via Gasthuys' formula. In order to compare the groups with previously published values for infants, we used resampling techniques to allow comparison to humans. RESULTS Renal weight was higher in humans than in Pietrain piglets (ΔL = 7.6 g; ΔR = 5.4 g) and Aachen Minipigs (ΔL = 11 g; ΔR = 9.4 g). Renal volumes in humans were higher than in both Pietrain piglets (ΔL = 5.6 mL, p < 0.001; ΔR = 3.7 mL, p = 0.004) and Aachen Minipigs (ΔL = 8.1 mL; ΔR = 6.6 mL; both p < 0.001). Ureteral lengths in humans and both pig breeds were comparable as were estimated renal functions between both pig breeds. DISCUSSION AND CONCLUSION Both landrace piglets and juvenile minipigs are suitable models for experimental pediatric urology as parameters did not differ between them. In addition, the anatomic parameters are comparable or smaller than in infants. This might facilitate translational research as technical failure is less likely in larger organs. Additional research is necessary to cover higher age ranges than those included in the present pilot study.
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Affiliation(s)
| | - Nikolaus Deigendesch
- Institut für medizinische Genetik und Pathologie, Universitätsspital Basel, Basel, Switzerland
| | - Andreas Lindner
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Jan Baumgart
- Translational Animal Research Center, Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Arne Schröder
- Klinik für Kinder- und Jugendmedizin, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Axel Heimann
- Institut für neurochirurgische Pathophysiologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Oliver J Muensterer
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
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Tagkalos E, Lindner A, Gruber G, Lang H, Heimann A, Grimminger PP, Muensterer OJ, Oetzmann von Sochaczewski C. Using simple interrupted suture anastomoses may impair translatability of experimental rodent oesophageal surgery. Acta Chir Belg 2020; 120:310-314. [PMID: 31012385 DOI: 10.1080/00015458.2019.1610263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background/purpose: Irreproducibility and missing translatability are major drawbacks in experimental animal studies. Hand-sewn anastomoses in oesophageal surgery are usually continuous, whereas those in experimental oesophageal surgery are widely performed using the simple interrupted technique. It has been implicated to be inferior in tolerating anastomotic tension, which we aimed to test in rats due to their importance as an animal model in oesophageal surgery.Methods: We determined linear breaking strengths for the native oesophagus (n = 10), the simple interrupted suture anastomosis (n = 11), and the simple stitch (n = 9) in 8-week old Sprague-Dawley rats. Experiments were powered to a margin of error of 10% around the results of exploratory investigations. The comparison of anastomotic resilience between native organ and simple interrupted suture anastomosis was a priori powered to 99%.Results: Native oesophagi sustained traction forces of 4.25 N (95% CI: 4.03-4.58 N), but the simple interrupted suture anastomosis had only 38.6% (Δ= -2.78 N, 95% CI: -2.46 to -3.11 N, p < .0001) of the resilience of native oesophagi.Conclusions: Oesophageal division and re-anastomosis markedly decreases resilience to traction forces compared to the native organ. This effect is even more pronounced in rats compared to other species and might impair transferability of results.
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Affiliation(s)
- Evangelos Tagkalos
- Department of General, Visceral and Transplant Surgery Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Andreas Lindner
- Department of Paediatric Surgery, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Gudrun Gruber
- Translational Animal Research Centre Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Axel Heimann
- Institute of Neurosurgical Pathophysiology Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Peter P. Grimminger
- Department of General, Visceral and Transplant Surgery Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Oliver J. Muensterer
- Department of Paediatric Surgery, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
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Nuber M, Lindner A, Baumgart J, Baumgart N, Heimann A, Schröder A, Muensterer OJ, Oetzmann von Sochaczewski C. Sex represents a relevant interaction in Sprague–Dawley rats: the example of oesophageal length*. ALL LIFE 2020. [DOI: 10.1080/26895293.2020.1806118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Maximilian Nuber
- Translational Animal Research Centre, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Lindner
- Department of Paediatric Surgery, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Jan Baumgart
- Translational Animal Research Centre, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Nadine Baumgart
- Translational Animal Research Centre, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Axel Heimann
- Institute of Neurosurgical Pathophysiology, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
| | - Arne Schröder
- Department of Paediatrics, Elisabeth-Krankenhaus Essen, Essen, Germany
| | - Oliver J. Muensterer
- Department of Paediatric Surgery, Universitätsmedizin Mainz der Johannes Gutenberg-Universität, Mainz, Germany
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Baumgart J, Deigendesch N, Lindner A, Muensterer OJ, Schröder A, Heimann A, Oetzmann von Sochaczewski C. Using multidimensional scaling in model choice for congenital oesophageal atresia: similarity analysis of human autopsy organ weights with those from a comparative assessment of Aachen Minipig and Pietrain piglets. Lab Anim 2020; 54:576-587. [PMID: 32063097 DOI: 10.1177/0023677220902184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Swine models had been popular in paediatric oesophageal surgery in the past. Although being largely replaced by rodent models, swine experienced a revival with the establishment of minipig models. However, none of them has ever been investigated for similarity to humans. We conducted a pilot study to determine whether three-week old Pietrain piglets and three-month old Aachen Minipigs are suitable for experimental paediatric oesophageal atresia surgery. We tested the operation's feasibility, performed a necropsy, weighed organs, measured organ length and calculated relative weights and lengths, and measured laboratory parameters. We used multidimensional scaling to assess the similarity of the swine breeds with previously published human data. Pietrain piglets had a higher a priori bodyweight than Aachen Minipigs (Δ = 1.31 kg, 95% confidence interval (CI): 0.37-2.23, p = 0.015), while snout-to-tail length was similar. Pietrain piglets had higher absolute and relative oesophageal lengths (Δ = 5.43 cm, 95% CI: 2.2-8.6; p = 0.0062, q1* = 0.0083 and Δ = 11.4%, 95% CI: 5.1-17.6; p = 0.0025, q3* = 0.0053). Likewise, absolute and relative small intestinal lengths were higher in Pietrains, but all other parameters did not differ, with the exception of minor differences in laboratory parameters. Multidimensional scaling revealed three-week old Pietrain piglets to be similar to two-month old humans based on their thoracoabdominal organ weights. This result indicates three-week old Pietrain piglets are a suitable model of paediatric oesophageal atresia surgery, because clinically many procedures are performed at around eight weeks age. Three-month old Aachen Minipigs were more dissimilar to eight-week old humans than three-week old Pietrain piglets.
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Affiliation(s)
- Jan Baumgart
- Translational Animal Research Centre, Johannes-Gutenberg-Universität Mainz, Germany
| | | | - Andreas Lindner
- Department of Paediatric Surgery, Universitätsmedizin Mainz, Germany
| | | | - Arne Schröder
- Department of Paediatrics, Elisabeth-Krankenhaus Essen, Germany
| | - Axel Heimann
- Institute for Neurosurgical Pathophysiology, Universitätsmedizin Mainz, Germany
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Hutson JM. Letter to the Editor. J Pediatr Surg 2019; 54:1725. [PMID: 31079863 DOI: 10.1016/j.jpedsurg.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- John M Hutson
- The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria 3052, Australia.
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Oetzmann von Sochaczewski C, Baumgart J, Muensterer OJ. Reply to letter to the Editor. J Pediatr Surg 2019; 54:1726-1727. [PMID: 31079864 DOI: 10.1016/j.jpedsurg.2019.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/19/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Christina Oetzmann von Sochaczewski
- Klinik und Poliklinik für Kinderchirurgie der Universitätsmedizin Mainz der Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany.
| | - Jan Baumgart
- Translational Animal Research Centre der Universitätsmedizin Mainz der Johannes-Gutenberg-Universität, Hanns-Dieter-Hüsch-Weg 19, D-55128 Mainz, Germany.
| | - Oliver J Muensterer
- Klinik und Poliklinik für Kinderchirurgie der Universitätsmedizin Mainz der Johannes-Gutenberg-Universität Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany.
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