Laparoscopic transgastric suturing for bleeding peptic ulcers.
BACKGROUND
Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the feasibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing.


METHODS
After approval of the Animal Ethics Committee, 20 pigs (20 kg) were anticoagulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was created. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior gastric ulcers were mechanically made on each pig by a "lift and cut technique." Ulcers were observed for at least 1 min for evidence of continued bleeding. First, bleeding ulcers were treated with sclerosing agents (epinephrine and ethanolmine oleate 5%); following sclerotherapy, ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots.


RESULTS
Ulcers created extended into the vascular submucosa and averaged 7 mm in diameter. Bleeding rate was variable, but significant (2 cm3/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerotherapy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement.


CONCLUSIONS
It is possible to technically control bleeding ulcers in most cases with a laparoscopic transgastric technique using sclerosing agent and intraluminal sutures. This approach is promising for future human application; also, the intragastric suturing skills developed may be useful for other surgical interventions.
Potvin
M
M
Department of Surgery, Hôtel-Dieu de Montréal, University of Montreal, Quebec, Canada.
Gagner
M
M
Pomp
A
A
D000818:Animals; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods*; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000601:surgery*; D013270:Stomach / Q000601:surgery*; D013276:Stomach Ulcer / Q000150:complications*; D013536:Suture Techniques; D013552:Swine