Omentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery procedures (with video).
BACKGROUND
The utility of the greater omentum has not been assessed in transluminal access closure after natural orifice transluminal endoscopic surgery (NOTES) procedures.


OBJECTIVE
Our purpose was to evaluate the feasibility, efficacy, and safety of omentoplasty for gastrotomy closure.


METHODS
Survival experiments in 9 female 40-kg pigs were randomly assigned to 3 groups: group A, endoscopic full-thickness resection (EFTR) for transgastric access and peritoneoscopy without closure; group B, ETFR and peritoneoscopy with omentoplasty (flap of omentum is pulled into the stomach and attached to the gastric mucosa with clips but no clips are used for gastrotomy closure itself); group C, balloon dilation for opening and peritoneoscopy followed by omentoplasty for closure. The animals were observed for 2 weeks and then underwent endoscopy and necropsy with histologic evaluation.


RESULTS
Transgastric opening and peritoneoscopy were achieved in all pigs. In groups B and C, a flap of omentum was easily placed to seal the gastrotomy and then attached to the gastric mucosa with 2 to 5 clips (median 4) in 7 to 20 minutes (median 15 minutes). In group A, peritonitis developed in all animals. In both groups B and C, all animals survived 15 days with no peritonitis and minimal adhesions outside the gastrotomy site. In addition, all achieved complete healing (transmural, n = 4; mucosal ulceration, n = 2) of the gastrotomy site. One animal in group B had an 18-mm abscess in the omental flap.


CONCLUSIONS
Animal model, small sample size, lack of appropriate controls for group C.


CONCLUSIONS
Omentoplasty of the gastrotomy site is a technically feasible method to seal balloon-created transgastric access to the peritoneal cavity after NOTES procedures.
Dray
Xavier
X
Division of Gastroenterology and Hepatology, Johns Hopkins School of Medicine, Baltimore, Maryland 21205, USA. xavier.dray@lrb.php.fr
Giday
Samuel A
SA
Buscaglia
Jonathan M
JM
Gabrielson
Kathleen L
KL
Kantsevoy
Sergey V
SV
Magno
Priscilla
P
Assumpcao
Lia
L
Shin
Eun J
EJ
Reddings
Susan K
SK
Woods
Kevin E
KE
Marohn
Michael R
MR
Kalloo
Anthony N
AN
D000818:Animals; D004195:Disease Models, Animal; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005260:Female; D009852:Omentum / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D013270:Stomach / Q000601:surgery*; D013524:Surgical Flaps; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D014945:Wound Healing