Replacement of the cervical and thoracic esophagus in dog using free jejunal autografts.

Abstract

Free revascularized jejunal grafts based on a single branch of the mesenteric artery and vein were selected and used for replacement of the cervical esophagus in 20 dogs. The graft pedicle was transplanted to the left external jugular vein and the internal carotid artery using end-to-side microvascular anastomoses. The procedure was successful in all the dogs; however, five dogs had fistula formation that healed spontaneously. A similar jejunal autograft was used to replace the thoracic esophagus in 20 dogs. The recipient vessels were the internal thoracic artery and vein. Only four dogs survived. Thirteen dogs could not survive because of infection resulting from leakage of esophageal content from the esophagojejunal anastomoses into the thoracic cavity. Only two dogs had infarcted jejunal grafts. The four surviving dogs could swallow liquid and semisolid food but they never returned to solid food because of difficulties with swallowing. Graft survival was confirmed with endoscopy and arterial angiography. Narrowed jejunal graft lumen was apparent with contrast radiography and endoscopy. The jejunal grafts kept peristalsis and contracted in coordinated fashion with the proximal esophagus. At necropsy, wound healing was evaluated using bursting strength and bursting circular wall tension. Although slight adhesion and fibrosis around the grafts as well as slight inflammatory reaction around the suture material were observed, the jejunal grafts were grossly and microscopically normal. All esophagojejunal anastomoses healed and the jejunal mucosa looked normal.