Endoscopy 2010; 42(4): 311-317
DOI: 10.1055/s-0029-1243938
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic sutured closure of a gastric natural orifice transluminal endoscopic surgery access gastrotomy compared with open surgical closure in a porcine model. A randomized, multicenter controlled trial

P.  O.  Park1 , M.  Bergström1 , R.  Rothstein2 , P.  Swain3 , I.  Ahmed4 , G.  Gomez4 , G.  S.  Raju4
  • 1Department of Surgery, South Älvsborg Hospital Bora˙s, Sweden
  • 2Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  • 3Department of Technology and Medicine, Imperial College of Science, London, United Kingdom
  • 4Department of Endoscopy, University of Texas Medical Branch, Galveston, Texas, USA
Weitere Informationen

Publikationsverlauf

submitted 3 March 2009

accepted after revision 21 December 2009

Publikationsdatum:
03. März 2010 (online)

Preview

Background and study aims: In natural orifice transluminal endoscopic surgery (NOTES) procedures it is essential to be able to perform secure closure of the access perforation. The aim of this study was to compare endoscopically sutured closure of a gastric access gastrotomy using the tissue apposition system (TAS), with closure via laparotomy in a randomized multicenter study.

Methods: A total of 32 pigs (18 – 42 kg) were used in this study. The gastric NOTES access was created using a needle knife and a 20-mm balloon. Following transgastric pelvic peritoneoscopy, the endoscope was withdrawn into the stomach. The animals were then randomized to endoscopic closure or laparotomy with surgical closure. Procedure time, recovery time, and weight gain were measured. At necropsy, adhesions, abscesses or peritonitis were recorded.

Results: Of the 32 pigs, 29 survived 14 days without complications. All endoscopic and all open surgical closures were secure at postmortem. On average two suture pairs were used for endoscopic closure. Surgical closure was quicker (12.5 vs. 20.1 minutes). Recovery time and postoperative weight gain were similar for both groups. Two pigs in the endoscopic group died: one of gastric dilatation, without leakage from the gastrotomy; another was euthanized due to rectal prolapse. In the laparotomy group one pig was euthanized after 7 days due to abdominal wound dehiscence. At necropsy there were significantly more intra-abdominal adhesions in the laparotomized group.

Conclusion: This randomized controlled study of endoscopic and surgical closure of a gastrotomy made for transperitoneal access for NOTES procedures suggests that both techniques are comparable in technical closure rates, postoperative recovery, and prevention of peritonitis. There were fewer adhesions in the endoscopic group.

References

P. O. ParkMD 

Department of surgery
South Älvsborg Hospital

50182 Bora˙s
Sweden

Fax: +46-33-6164009

eMail: per-ola.park@telia.com