Aim of the Study: Up to 20-30% of oesophageal atresia patients have a long-gap form, thus primary anastomosis is either impossible or requires high tension. Oftentimes, being able to perform a reasonable anastomosis depends on a few millimetres of tissue. We compared continuous to interrupted sutures for oesophageal anastomosis in terms of tensile strength.
Methods: Porcine oesophagi were obtained from a slaughterhouse (German landrace, 100-120kg; 160-180 days old). Oesophagi were divided at the carinal level and re-anastomosed in a standardised fashion by standardized continuous or simple interrupted suture technique. Oesophagi (n=eight/group) were mounted in a motorised horizontal test stand, subjected to traction until the sutures started to cut the oesophageal muscle (time point A), and until the underlying mucosa became visible (time point B). We gauged traction forces, calculated the achieved length gain and compared the two anastomotic techniques with Student’s t-test. As it did not involve live animals, the experiment was exempt from national laws for the protection of animals.
Main Results: While continuous anastomoses sustained 7.92N (95% CI: 0.79–15.06N; P=0.032) more traction forces than simple interrupted sutures for the endpoint of visible mucosa (B), there was no statistical difference for time point A, when the muscle started cutting through by the suture (Δ=0.31N, 95% CI: -5.57N–6.37N; P=0.914). The achieved length gain was 1.54cm (95% CI: 0.74–2.46cm; P=0.001; post-hoc statistical power 96%) higher in continuous anastomoses when the thread cut the oesophageal muscle (A) compared to simple interrupted suture anastomoses. This difference rose to 2.88cm (95% CI: 1.81–3.94cm; P<0.001; post-hoc statistical power 99.9%) at time point B. Regression analyses revealed no relationship between traction forces and length gain.
Conclusions: Continuous suturing creates stronger oesophageal anastomoses than does interrupted suturing. Continuous suturing might allow approximation of oesophageal ends under higher tension, thus enabling primary anastomosis.