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Esophagus stretch tests: Biomechanics for tissue engineering and possible implications on the outcome of esophageal atresia repairs performed under excessive tension

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Abstract

Background

Esophageal biomechanical studies are important to understand structural changes resulting from stretches during repair of esophageal atresias as well as to obtain values to compare with the biomechanics of tissue-engineered esophagus in the future. This study aimed to investigate light microscopic changes after uniaxial stretching of the ovine esophagus.

Methods

In vitro uniaxial stretching was performed on esophagi (n = 20) of 1-month-old lambs within 4–6 h post-mortem. Esophagi were divided into 5 groups: control and stretched (1.1, 1.2, 1.3 and 1.4). Force and lengthening were measured with 5 cycles performed on every specimen using a PBS organ bath at 37 °C. Histological studies were performed on the 5 groups.

Results

Low forces of ~ 2 N (N) were sufficient for a 1.2–1.25 stretch in the 1st cycle, whereas a three times higher force (~ 6 N) was needed for a stretch of 1.3. In the 2nd to 5th cycle, the tissue weakened and a force of ~ 3 N was sufficient for a stretch of 1.3. Histologically, in the 1.3–1.4 stretch groups, rupture of muscle fibers and capillaries were observed, respectively. Changes in mucosa and collagen fibers could not be observed.

Conclusions

These results offer norm values from the native esophagus to compare with the biomechanics of future tissue-engineered esophagus. Esophageal stretching > 1.3 leads to tears in muscle fibers and to rupture of capillaries. These findings can explain the decrease in microcirculation and scarring in mobilized tissue and possibly offer clues to impaired motility in esophagus atresias repaired under excessive tension.

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Acknowledgements

This research was funded by an European Union Grant within the 6th Framework Program (EuroSTEC; LSHC-CT-2006-037409). The authors would like to thank Mrs. Anna Kuess from the Unit of Experimental Fetal Surgery and Tissue Engineering, Medical University of Graz, Austria for her valuable support, and Mr. Georg Zeindlinger from the Institute of Biomechanics, Graz University of Technology, Austria for his support on the experimental tests.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Chelsea Children’s Hospital, Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, 369 Fulham Road, London, SW10 9NH, UK

    Amulya K. Saxena

  2. Department of Pediatric Surgery, Medical University of Pecs, Pecs, Hungary

    Ede Biro

  3. Institute of Biomechanics, Graz University of Technology, Graz, Austria

    Gerhard Sommer & Gerhard A. Holzapfel

  4. Norwegian University of Science and Technology, Trondheim, Norway

    Gerhard A. Holzapfel

Authors
  1. Amulya K. Saxena
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  2. Ede Biro
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  4. Gerhard A. Holzapfel
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Correspondence to Amulya K. Saxena.

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Ethical Statement

All experiments were performed according to the local and national research guidelines approved for the EuroSTEC project.

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Saxena, A.K., Biro, E., Sommer, G. et al. Esophagus stretch tests: Biomechanics for tissue engineering and possible implications on the outcome of esophageal atresia repairs performed under excessive tension. Esophagus 18, 346–352 (2021). https://doi.org/10.1007/s10388-020-00769-y

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  • DOI: https://doi.org/10.1007/s10388-020-00769-y

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