Bursting strength and collagen content changes in esophageal anastomoses. Comparative experimental study in dogs.

Background and Aims: The Biofragmentable Anastomosis Ring (BAR) is a mechanical device composed of absorbable material, performs an inverted anastomosis by atraumatic compression. It is a safe method recommended for bowel ends covered by serosal layer. The feasibility for esophageal surgery hasn't been proved. In our study we compared the healing of transsected intrathoracic esophagus anastomosed with BAR versus Stapler on an experimental dog model by evaluating the bursting strength (BS) and collagen (Hydroxyproline (HP)) concentration and content in different sites and defined time points after surgery (4(th), 7(th), 14(th), 28(th) day). Material and Methods: Forty-six mongrel dogs were randomly separated into two groups (28 BAR, 18 Stapler) and parameters of surgical repair evaluated after sacrification on certain days. Results: Although we had a total of 4 leaks (14,3 %) only in the BAR group (2 were clinically relevant and fatal), there was no significant difference in the leakage rate between the two groups. BS was significantly higher in the BAR group during the first week with values almost equal from the 14th day, in both groups. BS measurement reflects anastomotic strength only during the first two postoperative weeks. After this rupture is often produced outside the anastomotic line. HP concentration showed no significant differences from samples taken next to and far from the anastomotic line. The HP rate showed a significant reduction in the 4th and 711 day subgroups, and values close to the reference from the 14th day with both techniques. Conclusions: BS and HP changes proved a normal tissue repair with no significant difference, showing that both methods are suitable to perform anastomoses on the intrathoracic esophagus in mongrel dogs. The higher mechanical stability of the BAR anastomosis could suggest the feasibility of the method in conditions where higher mechanical strength is requested.