Strength of esophageal closure techniques with and without tissue reinforcement

Objective The purpose of this study was to investigate the effects of esophagotomy closure techniques on the esophageal bursting pressure. Materials and methods Altogether, 122 freshly dead sheep esophagi received from the local slaughterhouse were prepared for manual closure. After esophagotomy, the specimens were divided into four groups. An interrupted mucosal suture pattern (n = 30), an interrupted mucosal-submucosal suture pattern (n = 30), an interrupted mucosal-submucosal + over-over continuous muscular suture pattern (n = 32), and an interrupted mucosal-submucosal + reinforcement with a diaphragmatic part with full-thickness interrupted U suture pattern (n = 30) were used for esophagotomy closure; 4-0 silk was used in all specimens. Bursting pressures were measured with a sphygmomanometer. Results We found a statistically significant difference among the bursting pressures of all groups (p < 0.001). The bursting pressure values gradually increased from group 1 to group 4 (47.6 +/- 22.7, 86.2 +/- 49.5, 185.4 +/- 53.5, and 226.8 +/- 62.4 mmHg, respectively). Reinforcing the esophageal suture line with tissue significantly increased the bursting pressure compared to the other groups. Conclusions Each layer of the esophagus significantly contributes to strengthening esophageal wall tension with primary esophageal closure, and reinforcement of the esophageal suture with tissue provides an additional significant increase in the bursting pressure of the esophagus.