Effect of level of circular myotomy on oesophageal function in a piglet model
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Oesophageal continuity is often difficult to obtain in “long-gap” oesophageal atresia, and a circular myotomy may be required to achieve oesophageal anastomosis. This study compared the effects of upper and lower segmental circular myotomy on oesophageal stricture formation, oesophageal motility, and the development of gastro-oesophageal reflux (GOR) in a piglet model. Group I underwent mid-oesophageal resection with upper segment myotomy (14); group II mid-oesophageal resection with lower segment myotomy (8); and group III oesophageal transection and anastomosis without resection (6). Normal motility data were obtained from 8 unmanipulated piglets. The incidence of stricture formation was high in all operated groups. Pseudodiverticula developed in all piglets after proximal myotomy, but not after transection or distal myotomy. Lower oesophageal sphincter pressure and mean amplitude of upper oesophageal contractions were similar after operation in all groups and in controls. GOR (number of reflux episodes/24 h, number of episodes of reflux lasting more than 5 min, and fraction of time pH less than 4.0) was worse after operation compared to controls. Within each group most manometric parameters and GOR worsened with time. We found no evidence that the level of circular myotomy (upper or lower) resulted in any significant difference in stricture rate, oesophageal motility, or severity of GOR. Given the difficulty of performing an upper myotomy in long-gap atresia, where the upper segment is often very short and pseudodiverticulum formation is common, a lower-segment circular myotomy would appear to be a reasonable alternative.
Key wordsMyotomy Oesophageal atresia Oesophageal stricture Oesophageal diverticulum Gastro-oesophageal reflux
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