title: Endoloop application as an alternative method for gastrotomy closure in experimental transgastric surgery.
abstract: BACKGROUND
  Experimental studies investigating transgastric endoscopic surgery report closure of the gastric wall incision with clips. The author of this report describes endoloop placement as an alternative, equally efficient, faster method for gastrotomy closure.
  
  
  METHODS
  Eight female pigs with a mean weight of 30 kg were used. Abdominal endoscopic exploration and transgastric operations including hepatic biopsies, bilateral tubal ligation, cholecystectomy, and closure of the gastrotomy were performed. The experiment was divided into two parts. The first part included five animals, which were killed immediately after the procedure. The second part included five animals, which were kept alive and killed 15 to 20 days later.
  
  
  RESULTS
  The first part of the experiment, performed for technical skills acquisition, involved transgastric abdominal exploration, liver biopsies, and bilateral tubal ligation, which were successful for all five animals. The gastric wall incision was closed by applying clips in four animals and endoloops in one animal. During the autopsy at the end of the experiment, the sites of intervention were examined macroscopically. In the second part of the experiment, gastrotomy closure with endoloop application was performed in two animals and with clip application in one animal. All three animals survived, gained weight, and demonstrated no signs of infection. They were killed 15 to 20 days after the procedure, and no signs of intraabdominal infection were found. Cultures from the peritoneal cavity were negative. At necropsy, macroscopic and microscopic examination confirmed complete healing of the gastrotomy.
  
  
  CONCLUSIONS
  Transgastric endoscopic surgery is technically feasible and effective. The application of endoloops for closure of the gastric opening is a fast, easy, and equally safe alternative to clip placement.
authors.affiliation: Department of Surgery, Aretaieion Hospital, V. Sofias 76 avenue, 115 27, Athens, Greece. dkatsarelias@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Katsarelias
authors.forename: Andreas
authors.initials: A
authors.lastname: Polydorou
authors.forename: Athanasia
authors.initials: A
authors.lastname: Tsaroucha
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Pavlakis
authors.forename: Georgia
authors.initials: G
authors.lastname: Dedemadi
authors.forename: Leda
authors.initials: L
authors.lastname: Pistiolis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Karakostas
authors.forename: Agatha
authors.initials: A
authors.lastname: Kondi-Paphiti
authors.forename: Elias
authors.initials: E
authors.lastname: Mallas
mesh_terms: D000818:Animals; D013505:Digestive System Surgical Procedures / Q000379:methods; D016099:Endoscopy, Gastrointestinal; D005260:Female; D013270:Stomach / Q000601:surgery*; D013537:Sutures; D013552:Swine