Skip to main content

Advertisement

SpringerLink
Log in

Impact of botulinum toxin A injection on esophageal anastomosis in a rabbit model

  • Original Article
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

Purpose

The management of esophageal atresia is established, but the rate of postoperative complications remains high. We focused on a new, recently reported method of esophageal elongation using botulinum toxin type A (BTX-A) and evaluated the efficacy of BTX-A injection around esophageal anastomoses with tension in a rabbit model.

Methods

Twenty rabbits aged 8–10 weeks and weighing 1.27–1.72 kg underwent resections of the esophagus measuring 1.5 cm long using an anterior cervical approach. Esophagoesophagostomies were performed after intramural administration of Xeomin™ (3 U/body) in the BTX-A group and saline in the control group. Morphological and histological evaluations were examined on postoperative day 14.

Results

Six rabbits in each group survived. The BTX-A group showed significantly less postoperative anastomotic stricture and less fibrosis than the control group. Changes in wall thickness on both sides of the anastomotic areas were equivalent between the two groups, and no muscle fracturing was observed.

Conclusion

Local administration of BTX-A for esophagoesophagostomy significantly reduced postoperative anastomotic stricture with less fibrosis than that observed in the control group. Reduced anastomotic tension with BTX-A presumably contributed to better anastomotic healing. Determining the optimum dose of BTX-A is necessary for clinical application.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Spitz L (2014) Esophageal replacement: overcoming the need. J Pediatr Surg 49:849–852

    Article  PubMed  Google Scholar 

  2. Friedmacher F, Puri P (2012) Delayed primary anastomosis for management of long-gap esophageal atresia: a meta-analysis of complications and long-term outcome. Pediatr Surg Int 28:899–906

    Article  PubMed  Google Scholar 

  3. Serhal L, Gottrand F, Sfeir R, Guimber D, Devos P, Bonnevalle M, Storme L, Turck D, Michaud L (2010) Anastomotic stricture after surgical repair of esophageal atresia: frequency, risk factors, and efficacy of esophageal bougie dilatations. J Pediatr Surg 45:1459–1462

    Article  PubMed  Google Scholar 

  4. Thakkar HS, Cooney J, Kumar N, Kiely E (2014) Measured gap length and outcomes in oesophageal atresia. J Pediatr Surg 49:1343–1346

    Article  PubMed  Google Scholar 

  5. Larsen HF, Jensen TS, Rasmussen L, Ellebæk M, Qvist N (2013) Intramural injection with botulinum toxin significantly elongates the pig esophagus. J Pediatr Surg 48:2032–2035

    Article  PubMed  Google Scholar 

  6. Sun LY, Laberge JM, Yousef Y, Baird R (2015) The esophageal anastomotic stricture index (EASI) for the management of esophageal atresia. J Pediatr Surg 50:107–110

    Article  PubMed  Google Scholar 

  7. Ellebæk M, Qvist N, Rasmussen L (2013) Secondary anastomosis after preoperative botulinum type A toxin injection in a case with long gap oesophageal atresia. Eur J Pediatr Surg 23:325–326

    PubMed  Google Scholar 

  8. Ellebæk MB, Qvist N, Schrøder HD, Rasmussen L (2016) Intramural injection with botulinum toxin type A in piglet esophagus. The influencer on maximum load and elongation: a dose response study. Eur J Pediatr Surg 26:282–286

    PubMed  Google Scholar 

  9. Villegas-Alvarez F, Olvera-Durán J, Rodríguez-Aranda E, Carmona-Mancilla A, Vigueras-Villaseñor RM, Méndez-Ramírez I (2003) Esophageal anastomotic failure: an experimental study. Arch Med Res 34:171–175

    Article  PubMed  Google Scholar 

  10. Karen MT, Spencer AJ (2012) Veterinary surgery: small animal, 1st edn. Saunders Elsevier, St. Louis

    Google Scholar 

  11. Hackett R, Kam PC (2007) Botulinum toxin: pharmacology and clinical developments: a literature review. Med Chem 3:333–345

    Article  CAS  PubMed  Google Scholar 

  12. Gassner HG, Brissett AE, Otley CC, Boahene DK, Boggust AJ, Weaver AL, Sherris DA (2006) Botulinum toxin to improve facial wound healing: a prospective, blinded, placebo-controlled study. Mayo Clin Proc 81:1023–1028

    Article  CAS  PubMed  Google Scholar 

  13. Chang CS, Wallace CG, Hsiao YC, Chang CJ, Chen PK (2014) Botulinum toxin to improve results in cleft lip repair: a double-blinded, randomized, vehicle-controlled clinical trial. PLoS One 26:e115690

    Article  Google Scholar 

  14. Lee BJ, Jeong JH, Wang SG, Lee JC, Goh EK, Kim HW (2009) Effect of botulinum toxin type a on a rat surgical wound model. Clin Exp Otorhinolaryngol 2:20–27

    Article  PubMed  PubMed Central  Google Scholar 

  15. Arnold PB, Fang T, Songcharoen SJ, Ziakas G, Zhang F (2014) Inflammatory response and survival of pedicled abdominal flaps in a rat model after perivascular application of botulinum toxin type A. Plast Reconstr Surg 133:491e–498e

    Article  CAS  PubMed  Google Scholar 

  16. Schweizer DF, Schweizer R, Zhang S, Kamat P, Contaldo C, Rieben R, Eberli D, Giovanoli P, Erni D, Plock JA (2013) Botulinum toxin A and B raise blood flow and increase survival of critically ischemic skin flaps. J Surg Res 184:1205–1213

    Article  CAS  PubMed  Google Scholar 

  17. Khera M, Boone TB, Smith CP (2004) Botulinum toxin type A: a novel approach to the treatment of recurrent urethral strictures. J Urol 172:574–575

    Article  PubMed  Google Scholar 

  18. Sahinkanat T, Ozkan KU, Ciralik H, Ozturk S, Resim S (2009) Botulinum toxin-A to improve urethral wound healing: an experimental study in a rat model. Urology 73:405–409

    Article  PubMed  Google Scholar 

  19. Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57

    Article  PubMed  Google Scholar 

  20. Kelly EA, Koszewski IJ, Jaradeh SS, Merati AL, Blumin JH, Bock JM (2013) Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann Otol Rhinol Laryngol 122:100–108

    Article  PubMed  PubMed Central  Google Scholar 

  21. Scholes MA, McEvoy T, Mousa H, Wiet GJ (2014) Cricopharyngeal achalasia in children: botulinum toxin injection as a tool for diagnosis and treatment. Laryngoscope 124:1475–1480

    Article  PubMed  Google Scholar 

  22. Brisinda G, Sivestrini N, Bianco G, Maria G (2015) Treatment of gastrointestinal sphincters spasms with botulinum toxin A. Toxins (Basel) 29:1882–1916

    Article  Google Scholar 

Download references

Acknowledgments

The authors thank the technician Nobuko Nishiaki (Department of Surgery, Jichi Medical University School of Medicine) for the histological studies.

Author information

Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan

    Yoshiko Usui & Shigeru Ono

Authors
  1. Yoshiko Usui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shigeru Ono
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shigeru Ono.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Usui, Y., Ono, S. Impact of botulinum toxin A injection on esophageal anastomosis in a rabbit model. Pediatr Surg Int 32, 881–886 (2016). https://doi.org/10.1007/s00383-016-3936-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00383-016-3936-8

Keywords

Search

Navigation