Type of pledget and suture technique relative to esophageal tensile strength in long-gap esophageal atresia.

PURPOSE: We aimed to investigate whether pledget presence, pledget composition, and full versus partial thickness suture technique affect the force esophageal tissue can withstand before tearing.

METHODS

A right thoracotomy was performed on 10 deceased fetal sheep, 110-114 days gestation. The esophagus was divided at the level of the carina and 2 cm of tissue was removed to mimic long-gap esophageal atresia. The pouches were sutured with horizontal mattress non-absorbable braided polyester suture using one of three methods: polytetrafluoroethylene (PTFE) pledgets, bovine pericardial pledgets, or no pledget, in full or partial thickness manner. Each suture was attached to a tensiometer and manually tightened at 50 gram-force / 30 s. Maximal force before esophageal tearing and time to tearing were measured. Results were compared using a linear mixed model.

RESULTS

PTFE pledgets withstood significantly more force than pericardial pledgets (p = 0.029) and provided longer duration before tearing compared to no pledget (p = 0.017) and pericardial pledgets (p = 0.047). Full versus partial-thickness technique made no difference.

CONCLUSION

In a deceased fetal lamb long-gap esophageal atresia model, PTFE pledgets improved tissue resistance to tearing (PTFE > pericardial) and prolonged stretch duration (PTFE > pericardial or no pledget). Suture thickness (full vs. partial) made no difference.