Serosal patch of the gastroesophageal junction an experimental study in dogs

RESUMO

Thirty two dogs were operated on in order to evaluate the mucosal regeneration of the serosal patch at the gastroesophageal junction. The operation began with a cardiotomy involving one centimeter of the esophagus and two centimeters of the stomach, originating an elliptical serosal surface three centimeters long and one centimeter large, turned to the digestive lumen. The animals were divided into four groups of eight dogs each and named 1,2,3 and 4; they were sacrified after one, two, four and eight weeks respectively. The results were evaluated by post-operative clinical aspects, macro and microscopic analysis. Post-operative morbidity was low, without signs of digestive tract obstruction. Macroscopically, the patch area at the first week became an ulcerated lesion, with a necrotic bottom; at the second and fourth weeks there was a progressive reduction of the ulcer, from its boundaries to the center, until the complete healing at the eighth week. Microscopically, the serous membrane disappeared early and it was replaced by inflamatory cells and severe neovascular formation, which fitted as a bed to the epithelial proliferation. The neo-epithelization occurred from the periphery to the center lesion. At the esophagus this process was completed within two weeks, with multiple layers of cells, at the stomach, within four weeks, with an unicellular epithelium. The corium, showing an inflamatory reaction at the first week, with fibrinoid necrosis and polimorphonuclear cells, changed to a fibroblastic proliferation with mononuclear cells at the second and fourth weeks and, finally, to fibrosis at the eighth week. In the animals sacrified lately there was regeneration of the snooth muscle layer of the esophagus. At electronic microscopy, the neo-epithelium of the esophagus had all the layer which constitute the normal esophageal epithelium.