Experimental replacement of thoracic esophageal segment with a biomaterial artificial esophagus in dogs

Abstract

Objective To implant 80 mm-long artificial esophagi constructed of biomaterial in dogs, observe the perioperative survival rates and the incidence of postoperative complications, and study the mechanisms of postoperative healing. Methods Specimens of the implanted esophagus, the “neo-esophagi”, were taken for histopathologic study 1, 3, 6, 12, 24 months after operation. Results The incidence of anastomotic leakage after the artificial esophagus implantation was 3.33%. The perioperative survival rate was 96.67%. The incidence of postoperative stenosis in the “neo-esophagi” was 81.48%; the stenoses were treated by expanding with esophagoscopy and implanting a stent. Epithelization of the mucosa in the “neo-esophagi” was completed in 3 to 6 months after surgery. Structures such as submucosal muscle layers, mucous glands, nerve fibers, capillaries, etc. were regenerated after 12 months, and then reconstruction of the fibrous connective tissue layer was completed. Conclusion Implanting a biomaterial artificial esophagus accomplishes safe reconstruction of defects in the esophagus. Advanced cellular structure of “neo-esophagus” can be regenerated after 1 year. Postoperative stenosis, which is related to hyperplasia and retraction of scar tissue, is still the most common complications which limiting the clinical application of the artificial esophagus.