Esophagectomy and Gastric Substitution in Dogs? A Cadaveric Study

In this cadaveric study we developed a novel surgical technique for replacement of the esophagus with a tube created from the stomach. The technique is based on the transhiatal esophagectomy which is a technique used in man for esophageal replacement. Ten canine cadavers, weighing 20kg to 40kg were used in this study. The dogs were divided into two groups based on the technique used to tube the stomach. The length of the sternum, the chest perimeter and the distance from the larynx to the pubis were measured. A ventral midline approach to the peritoneal cavity was performed and the perimeter of the stomach and the length of the lesser and greater curvatures was measured. The right gastric and right gastroepiploic arteries were canulated and injected with methylene blue to document the area of the stomach wall perfused by these arteries. The abdominal esophagus was freed from the esophageal hiatus of the diaphragm, cut and both ends oversewed. The esophageal hiatus was closed with a single layer continuous suture pattern. The short gastric, left gastric and left gastroepiploic arteries and veins, were identified, isolated, ligated and cut. In addition, the superficial leaf of the greater omentum, lesser omentum and gastrosplenic ligament were isolated, ligated and cut. The stomach was tubed using one of two techniques.The perimeter and length of the tubed stomach was measured. The cervical esophagus was approached ventrally and isolated at the thoracic inlet. A rigid endoscope was placed into the cranial mediastinum via this approach. The thoracic esophagus was released from the mediastinum, with a combination of endoscopic assisted blunt dissection and cranially traction of the cervical esophagus. The gastric tube was passed into the thoracic cavity via an incision in the diaphragm on the right. The tube was pulled into the cervical region and anastomosed to the cervical esophagus. Preliminary and final measurements were calculated and compared between the two groups using ANOVA (a = 0.05). The entire stomach except for the fundus was perfused by the right gastric and right gastroepiploic arteries. The stomach tube created by removal of the fundus (27.60 cm ± 1.34 cm) was shorter than the stomach tube created by removal of the two elliptical pieces of stomach wall (30.70 cm ± 7.40 cm). All the stomach tubes were long enough to reach the neck without significant tension in all but one case. Both methods caused stomach volume reduction of ~50% and were similar with respect to blood supply. The esophageal replacement procedure we developed proved successful as it allowed for complete removal of the thoracic esophagus in all dogs.