Endoscopic pyloroplasty with full-thickness transgastric and transduodenal myotomy with sutured closure.
BACKGROUND
Pyloroplasty with myotomy and sutured closure is a surgical treatment for gastric outlet obstruction. It has not been previously performed at flexible endoscopy.


OBJECTIVE
To develop and test a method for performing a sutured pyloroplasty at flexible endoscopy.


METHODS
A Heinicke-Miculicz pyloroplasty was performed, forming a linear myotomy through the pylorus from the gastric side into the duodenal bulb. This was subsequently sutured transversely to increase the opening. The operation was performed in 3 nonsurvival studies in pigs. The safety and the efficacy was then studied in 7 animals followed for up to 4 weeks after the procedure.


METHODS
The studies were performed in experimental surgical units in Gothenburg, Sweden, and London, UK.


METHODS
A linear needle-knife incision was made through the pylorus; full-thickness sutures, by using a new T-tag and polypropylene thread suturing system through a flexible gastroscope, were placed to close the incision transversely. In 2 pigs, the prepyloric bulge was excised before the pyloroplasty.


RESULTS
Pyloroplasty was readily accomplished at flexible endoscopy in the 3 nonsurvival studies. Six of 7 pigs that survived in this study for periods of 7 to 28 days, recovered well, without complications. One pig (with bulge removal) developed gastric retention. The pyloric opening was increased; it was then easy to enter the duodenum at follow-up endoscopy.


CONCLUSIONS
This method has yet to be studied clinically.


CONCLUSIONS
Pyloroplasty with full-thickness pyloromyotomy and transverse closure of a linear myotomy was accomplished by using a simple flexible endosurgical technique to test a new flexible suturing system.
Park
Per-Ola
PO
Department of Surgery, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.
Bergström
Maria
M
Ikeda
Keiichi
K
Fritscher-Ravens
Annette
A
Mosse
Sandy
S
Kochman
Michael
M
Swain
Paul
P
D000818:Animals; D004386:Duodenum / Q000601:surgery; D020699:Gastroscopes; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D009130:Muscle, Smooth / Q000601:surgery; D011708:Pylorus / Q000601:surgery*; D013536:Suture Techniques / Q000009:adverse effects; D013552:Swine