Lateral reinforcement of anastomoses enhances mechanical strength in fragile neonatal oesophageal tissue.

Anastomotic leakage is a major complication in neonatal oesophageal surgery, particularly in fragile tissues such as long-gap oesophageal atresia. In this study, we evaluate a simple suture modification, known as lateral reinforcement, to improve anastomotic stability and reduce leakage. Mechanical testing was performed using artificial oesophagus models and rat intestinal tissue, comparing standard sutures with and without lateral reinforcement. Tearing force and displacement were measured using a load-displacement device and motion-tracking software. Lateral reinforcement increased tissue-tearing resistance 3.5-fold in artificial models and 2.3-fold in animal models relative to standard sutures. Reinforced constructs also showed greater displacement before failure, indicating improved stress distribution and reduced focal tension. Clinically, the technique was applied in six thoracoscopic repairs of oesophageal atresia complicated by intraoperative tearing, with no postoperative leakage observed. These results suggest that lateral reinforcement enhances mechanical strength and may reduce anastomotic failure in high-risk neonatal cases. Further clinical evaluation using larger cohorts is needed to assess long-term healing and potential effects on stricture formation.Level of evidence: III.