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J Thorac Cardiovasc Surg 1999;118:276-286
© 1999 Mosby, Inc.

GENERAL THORACIC SURGERY

INTRATHORACIC ESOPHAGEAL REPLACEMENT IN THE DOG WITH THE USE OF AN ARTIFICIAL ESOPHAGUS COMPOSED OF A COLLAGEN SPONGE WITH A DOUBLE-LAYERED SILICONE TUBE

From the Institute for Frontier Medical Sciences, Field of Clinical Application, Department of Bioartificial Organs, Kyoto University,^a and the Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine and Faculty of Medicine,^b Kyoto, Japan.

Address for reprints: Yasumichi Yamamoto, MD, Institute for Frontier Medical Sciences, Kyoto University, 53 Shogoin, Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.

Objectives: Intrathoracic esophageal replacement with an artificial esophagus is considered difficult. We attempted to replace the intrathoracic esophagus with an artificial esophagus composed of a collagen sponge with a double-layered silicone tube and examined the state of host tissue regeneration.
Methods: A 5-cm long gap was created in the intrathoracic esophagus in 9 dogs and repaired by interposition of our prosthesis. The dogs were fed only by intravenous hyperalimentation for 28 days. The silicone tube was removed at 29 days after the operation, and oral feeding was reintroduced.
Results: One dog was put to death at each of the following times: 1, 2, 3, 3, 6, 12, and 24 months after the operation. One dog is still surviving without problems after more than 26 months. One dog died of malnutrition at 10 months. In all dogs, the host regenerated tissue had replaced the resulting gap at the time of silicone tube removal. The mucosa had fully regenerated within 3 months and the glands within 12 months. The process of stenosis and shrinkage was complete within 3 months and did not advance thereafter. The lamina muscularis mucosae were observed as islets of smooth muscle within 12 months. Although the skeletal muscle regenerated close to the anastomoses, it did not extend to the middle of the regenerated esophagus even after 24 months.
Conclusions: Use of a collagen sponge with a double-layered silicone tube was shown to be feasible even in the thorax and to allow the regenerated host tissue, consisting of the mucosa, glands, and lamina muscularis mucosae, to replace the esophageal gap.

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