Circular Myotomy Research Articles

Circular Myotomy as an Aid to Resection and End-to-End Anastomosis of the Esophagus

Segments ranging from 40 to 70% of the thoracic esophagus were resected in 80 mongrel dogs. End-to-end anastomosis was effected after circular myotomy either proximal or distal, or both proximal and distal, to the anastomosis. Among dogs undergoing resection of 60% of the esophagus, distal myotomy enabled 6 of 8 animals to survive, and combined proximal and distal myotomy permitted 8 of 10 to survive. Cineesophagography was performed in a majority of the 50 surviving animals and showed no appreciable delay of peristalsis at the myotomy sites. When these sites were examined at postmortem examination up to 13 months after operation, 1 dog showed a small diverticulum but none showed dilatation or stricture. It is concluded that circular myotomy holds real promise as a means of extending the clinical application of esophageal resection with end-to-end anastomosis.

The value of circular myotomy for esophageal atresia

The joining of widely separated proximal and distal esophageal segments in esophageal atresia remains a challenging problem. Livaditis introduced the operation of circular myotomy as an effective means of bridging such a wide gap. Three babies with esophageal atresia were successfully treated in this manner at the Hospital for Sick Children, Toronto, during the 1st 6 mo of 1976. No alterations in blood supply of the upper esophageal pouch were observed, and elongations of at least 1 cm per myotomy were obtained. No unusual postoperative radiographic observations were noted. Our small clinical experience suggests that circular myotomies aid in reducing long esophageal gaps in some infants with esophageal atresia, thus permitting primary esophageal anastomosis.

Circular myotomy to decrease the tension of anastomosis in esophageal atresia : E. Kontor, T. Verebély, and E. Kun. Gyermekgyógyászat 27: 105–107, 1966

Circular myotomy to decrease the tension of anastomosis in esophageal atresia : E. Kontor, T. Verebély, and E. Kun. Gyermekgyógyászat 27: 105–107, 1966

Circular Myotomy of the Esophagus: Clinical Application in Esophageal Atresia

Three infants born with esophageal atresia that was repaired by end-to-end anastomosis combined with a circular myotomy on the upper segment are reported. The distance between the free surgical margins of the esophagus ranged between 1.5 and 4.5 cm. The esophageal myotomy was used to reduce the tension on the anastomosis. The suture line healed in each patient without clinical or roentgenographic evidence of breakdown. Followup of these patients ranged between 10 months and 3 years. Roentgenographic evaluation of their esophageal motility showed efficient peristaltic activity in the distal esophageal segment. Two of the patients had a subsequent history of impaction of solid particles in the upper esophageal segment at the age of 13 months and 2 years. The possibility that the circular myotomy contributed to this increased incidence of impaction is raised.

The use of circular myotomy to facilitate resection and end-to-end anastomosis of the esophagus : An Experimental Study. J. Muangsombut, J. R. Hankins, G. R. Mason, and J. S. McLaughlin. J. Thorac Cardiovasc. Surg. 68:522–535 (October), 1974

The use of circular myotomy to facilitate resection and end-to-end anastomosis of the esophagus : An Experimental Study. J. Muangsombut, J. R. Hankins, G. R. Mason, and J. S. McLaughlin. J. Thorac Cardiovasc. Surg. 68:522–535 (October), 1974

The use of circular myotomy to facilitate resection and end-to-end anastomosis of the esophagus: An experimental study

Segmental resection of the thoracic esophagus with end-to-end anastomosis carries a lower mortality rate than esophagogastrostomy or colon interposition. However, if more than a few centimeters is resected, the anastomosis fails because of tension. An experimental study is presented in which circular myotomy was utilized to reduce tension and thereby increase the amount of esophagus which could be resected successfully. Sixteen dogs were first subjected to end-to-end anastomosis without myotomy after resection of segments varying from 4 to 7 cm. in length and comprising 20 to 40 per cent of the esophagus. In other dogs, circular myotomy was performed 3 cm. proximal to the anastomosis after resection of 40 to 50 per cent of the esophagus. However, initial attempts failed because of ischemia leading to anastomotic breakdown. The myotomy interrupted important vessels running longitudinally in the deeper layers of the muscularis. Subsequently, we determined that partial circular myotomy afforded just as great a reduction in tension without compromising the blood supply. Our studies show that this technique permits successful resection of much longer segments than would otherwise be possible.

Esophageal end-to-end anastomosis. Reduction of anastomotic tension by circular myotomy.

The effect on anastomotic tension of circular myotomy of the esophagus was studied in 25 piglets by direct measurements and in terms of primary anastomotic healing and survival. Operations were performed either in the cervical or in the thoracic region and consisted of end-to-end anastomosis after resection of a determined length of esophagus and circular myotomy. The maximal length of resection involved 43 % of the cervical and 36% of the thoracic esophagus, respectively. Following myotomy, a 66% average reduction of anastomotic tension occurred regardless of the site or the extent of esophageal resection. Postoperatively the animals were unrestricted, had free access to food and received no adjunctive therapy. The mortality was nil. The average observation period in the entire series was 11 weeks. The anastomoses healed invariably without evidence of leak. In 10 animals the anastomotic width was normal, while in 15 it was decreased. The muscular manchette distal to myotomy remained intact. There were no...