Self-expanding removable plastic stents for the protection of surgical anastomoses after esophageal replacement in a porcine model.

BACKGROUND: Esophageal replacement by biological graft is associated with a high risk of anastomotic leak-related mediastinitis. OBJECTIVE: To determine whether a self-expanding plastic stent can help avoid anastomotic leak after full-thickness replacement of the esophagus in a porcine model. DESIGN: Experimental feasibility study in a porcine model. SUBJECTS: Twelve pigs were analyzed in the study. INTERVENTIONS: Replacement of a 2-cm-long segment of the cervical esophagus by an aortic allograft was performed in 12 pigs, with 6 pigs used as graft donors. Animals were divided into 2 groups depending on whether a self-expanding removable plastic stent protecting the 2 aortoesophageal anastomoses was inserted (n = 7) or not (n = 5), and were allowed to eat 24 hours postoperatively. MAIN OUTCOME MEASUREMENTS: The relative occurrence of mediastinitis caused by anastomotic leakage in stented and nonstented groups was assessed; endoscopic evaluation and histological analysis of the graft area were performed 1 month after esophageal replacement. RESULTS: All animals (n = 5) without stent insertion died of anastomotic leakage within 20 days of surgery. Two of the 7 stented animals died at day 2, and 5 survived 1 month in good clinical condition. Two stent migrations were noted. Stent extraction was followed by the development of a fibrous stricture. CONCLUSIONS: The use of a self-expanding plastic stent seems to allow leak-free healing after circumferential replacement of the esophagus by a biological graft in a porcine model.