USE OF VICRYL MESH TO SUPPORT THE ESOPHAGEAL WALL AFTER CIRCULAR MYOTOMY (LIVADITIS PROCEDURE) IN LONG-GAP ESOPHAGEAL ATRESIA - AN EXPERIMENTAL-STUDY

Circular esophageal myotomy (GEM) is currently a well-accepted techniq ue for elongation of the upper esophageal pouch in cases of long-gap e sophageal atresia (EA). Esophageal pseudodiverticulum is a frequent an d perhaps underreported sequela of this technique, characterized by ba llooning or outpouching of the esophageal mucosa in the myotomized are a. The present study was designed to seek a supplement for the CEM tec hnique in order to avoid possible pseudodiverticulum formation in the myotomized area, We created an animal model to simulate the anatomic c onditions present after primary repair of EA facilitated by CEM. Three groups of dogs underwent either cervical (1 group) or thoracic (2 gro ups) esophageal myectomy. In the cervical and first thoracic groups, t he denuded mucosa was left without any support. In the second thoracic group, the denuded mucosal area was wrapped with polyglactin 910 (Vic ryl) mesh. In all three groups the esophagus was narrowed by a Marlex mesh ring 3 cm distal to the myectomized zone, simulating a condition resulting from anastomotic narrowing. The dogs underwent barium swallo ws under fluoroscopy at different postoperative periods and were kille d 4 or 6 months after surgery. The esophagi were removed for gross and radiologic investigation under maximal insufflation as well as for hi stologic assessment. The proposed canine model proved to be useful for study of the myectomized esophagus, mimicking the anatomy and conditi ons after CEM in long-gap EA repair. Wrapping the denuded mucosa with Vicryl mesh fortified the weakened esophageal wall, thus diminishing t he likelihood of future pseudodiverticulum development, In light of th e simplicity of the technique and the absence of any evident risk or c omplications, we recommend that the use of Vicryl mesh wrap be conside red during CEM to reinforce the esophageal wall.