Experimental technique of esophageal substitution: intrathoracic interposition of a pedunculated gastric tube (PGT) preserving cardiac function. Preliminary results

BACKGROUND/AIMS: The authors present an experimental technique performed on piglets to replace a segment of the thoracic esophagus with a gastric tube pedunculated on gastroepiploic vessels transposed between proximal and distal esophageal segments, and consequently preserve cardiac function. METHODOLOGY: Four piglets aged between 30 and 75 days, weight 6-20 kg, underwent esophageal replacement with a gastric tube, length 6-10 cm (mean: 8 cm), constructed from the greater gastric curvature and pedunculated on the gastroepiploic vessels. The gastric tube thus obtained, it was transposed into the right hemithorax through a small opening in the diaphragm. Esophageal reconstruction was done by interposition of the gastric tube between the upper and lower esophageal stumps. RESULTS: The post-operative course was uneventful. An esophagogram on the 4th post-operative day showed no anastomotic leakage in all cases, and oral food intake could be commenced. At follow-up, the animals were found to be eating normally. CONCLUSIONS: This experimental technique could have important advantages over existing techniques of esophageal replacement: 1) cardiac function is preserved; 2) it is technically easy to obtain a gastric tube with a long vascular pedicle, so replacement up to the superior esophagus is possible; and, 3) in the post-operative period, no swallowing difficulties appear to occur.