Duygu MERGAN İLİKLERDEN, Ümit Haluk İLİKLERDEN, Ozan OKYAY, İbrahim ÖZALP, Orhan BEGER, Serhat BİNİCİ, Burhan BEGER, Caner KAYIKCI

Farklı Özofagogastrik Anastomoz Tekniklerinin Basınç Dirençlerinin Karşılaştırılması: Bir Ex Vivo Küçükbaş Hayvan Modeli Çalışması

Giriş: Özofagus kanseri ameliyatlarında konvansiyonel özofagus (CEAT) ve bölge genişletici anastomoz teknikleri (REAT) gibi mevcut anastomoz tekniklerinin yüksek mortalite ve morbidite oranlarına sahip olması, altın standart bir yöntemin eksikliğinin altını çizmektedir. Anastomoz teknikleri, darlık oluşumundan sorumlu faktörlerden biridir. Bu bağlamda, ex vivo koyun dokuları üzerinde yapılan çalışmada, farklı anastomoz tekniklerinin basınç dirençlerinin darlık oluşumu açısından karşılaştırılması amaçlanmıştır. Materyal-Metod: Çalışma için 12 aylık 35 erkek kuzudan alınan otuz beş yemek borusu ve mide örneği ex vivo olarak kullanıldı. Örnekler anastomoz tekniklerine göre El Yapımı Dikiş Tekniği (HM), Circular Stapler Sütürlü Tekniği (CS), Reinforced Circular Stapler Sütürlü Tekniği (rCS), Modifiye Plus “+” İnsizyon Tekniği (mP+IT), ve Modifiye Ok-Yay El Yapımı Dikişli Tekniği (mabHM). CEAT (örn. HM, CS ve rCS) ve REAT'in (örn. mP+IT ve mabHM) intraluminal basınç direnci kaydedildi. Bulgular: En yüksekten en düşüğe farklı kesi tekniklerinin basınçları şu şekilde bulundu: rCS (114.71±3.77 cm H2O) > CS (95.43±3.45 cm H2O) > HM (84.14±3.67cm H2O) > mabHM (79.71±2.87 cm H2O) > mP+IT (77.14±6.23 cm H2O) (p < 0.001). HM ile mabHM'nin (p=0,558) ve mP+IT ile mabHM'nin karşılaştırılması dışında, diğer teknikler birbirinden istatistiksel olarak önemli ölçüde farklıdır. Sonuç: Çalışmamızda CEAT kullanılan anastomozların dayanıklılığı daha yüksek ve literatürle uyumlu bulundu. İn vivo canlı hayvan çalışmaları gerekli olmakla birlikte, özofagogastrik anastomozların en sık görülen ikinci komplikasyonu olan darlık gelişimini önlemek için REAT güvenle kullanılabilir. Bulgularımız, sızıntıyı önlemek için CEAT'ın özellikle rCS'nin güvenli bir şekilde uygulanabileceğini göstermektedir.

Anahtar Kelimeler:

esophagogastric anastomosis, stricture, surgical techniques, esophagus, stomach

Comparison of Pressure Resistances of Different Esophagogastric Anastomosis Techniques: An Ex Vivo Ovine Model Study

Background: Current anastomosis techniques including conventional esophageal (CEAT) and region expanding anastomosis techniques (REAT) in esophagus cancer surgeries have high mortality and morbidity rates, which underlines the lack of a golden standard method. Anastomosis techniques are one of responsible factors for stricture formation. In this regard, the study conducted on ex vivo ovine tissues was aimed to compare pressure resistances of different anastomosis techniques in term of stricture formation. Methods: Thirty-five esophagus and gastric samples from 35 male lambs aged 12 months were used ex vivo for the study. Samples were divided into 5 groups according to anastomosis techniques including Hand-Made Sutured Technique (HM), Circular Stapler Sutured Technique (CS), Reinforced Circular Stapler Sutured Technique (rCS), Modified Plus “+” Incision Technique (mP+IT), and Modified Arrow-Bow Hand-Made Sutured Technique (mabHM). The intraluminal pressure resistance of the CEAT (e.g. the HM, CS and rCS) and REAT (e.g. the mP+IT and mabHM) were recorded. Results: The pressures of different incision techniques from the highest to the lowest were found as follows: the rCS (114.71±3.77 cm H2O) > the CS (95.43±3.45 cm H2O) > the HM (84.14±3.67cm H2O) > the mabHM (79.71±2.87 cm H2O) > the mP+IT (77.14±6.23 cm H2O) (p < 0.001). Except the comparison of the HM versus the mabHM (p=0.558), and the mP+IT versus the mabHM, the other techniques differ statistically significantly from each other. Conclusion: In our study, the durability of anastomoses using CEAT was found to be higher and compatible with the literature. Although in vivo live animal studies are necessary, REAT can be safely used to prevent the development of stricture, which is the second most common complication of esophagogastric anastomoses. Our findings suggest that the CEAT especially the rCS can be safely administered to prevent leakage.

Keywords:

Esophagogastric Anastomosis, Stricture, Surgical Techniques, Esophagus, Stomach,

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