J.Jpn. Surg. Soc.. 61(1): 98-110, 1960

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ALLOPLASTY OF THE ESOPHAGUS AND TRACHEA USING VARIOUS ARTIFICIAL MACROMOLECULE ORGANIC COMPOUNDS. EXPERIMENTAL AND CLINICAL STUDY.

Up to date, it has been discussed extensively that plastic materials were applied for the purpose of a reconstruction following partial resection of the esophagus and trachea. However, its clinical applications seem to be still dangerous for leakage or stricture of the repaired portions.
In order to overcome this problem, the author studied on alloplasties of the esophagus and trachea using various artificial macromolecule organic compounds, and the results obtained were as follows:
A. Alloplasty of the esophagus.
1. Using 25 dogs, the experimental study on reconstruction of the thoracic esophagus was performed with a specially prepared Polyethylen tube or a Silicon-rubber-polyethylen tube.
2. These plastic tubes were replaced on the esophageal defect with two lined purse string sutures.
3. The replaced portion was covered with mediastinal pleura or a free piece of autogenous fascia.
4. By this simplified method, successful results were obtained in 72 per cent of all experiments. Macroscopically, on evidence of cicatric stricture was found in the sacrified cases in six months postoperatively. Microscopically, regenerative ability of the squamous epithelium from each cut end of the esophagus was found at about 3 mm. of the distance per week.
5. Clinical applications in 4 cases of carcinoma of the midthoracic esophagus were accomplished sufficiently for the purpose of its reconstruction, though 3 patients have died; two cases died of metastases after the operations 7 months and 2 months respectively, one case died of a complication of bronchopneumonia. And another case survived with an excellent condition for two months postoperatively.
B. Alloplasty of the trachea.
1. Using 38 dogs, reconstruction of the complete or partial defect of the cervical and thoracic trachea and repair of the bifurcation were performed with the plastic materials.
2. The materials used were a specially prepared Polyethylen tube or a Silicon-rubber-polyethylen tube for replacement following the complete resection and Ivalon sponge or Saran-polyethylen mesh for partial defect of the tracheal wall, and finally Ivalon or Polyethylen Y-tube for resection of the bifurcation.
3. On the reconstruction of partial defect, successful results were obtained with no evidence of cicatric constriction and there is a renewed epithelial lining in the sacrified case even at 13 months postoperatively.
4. For the complete defect, a Silicon-rubber-polyethylen tube with 22A steel wire hook was found successfully to be freed from postoperative leakage or stricture and pulmonary complications. Though the reconstruction of the bifurcation was only temporarily successful, all cases were developed pulmonary complication within one month postoperatively.
5. Clinical application in a case of carcinoma of the thyroid gland who had a partial defect of the cervical trachea was accomplished successfully with Saran-polyethylen mesh and no stricture or other complications in 4 months postoperatively.
(Author's abstract)

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