Loop-anchor purse-string versus endoscopic clips for gastric closure: a natural orifice transluminal endoscopic surgery comparison study using burst pressures.
BACKGROUND
The success of natural orifice surgery depends on a reliable, secure closure of the opening in the gut. Few tests of the integrity of these closures have been published.


OBJECTIVE
To determine whether a gastrotomy can be closed safely and effectively from within the stomach by using looped T-anchors-a novel, endoscopically placed device.


METHODS
Head-to-head comparison trial of 2 closure methods in 9 explanted porcine stomachs.


METHODS
Animal laboratory.


METHODS
Paired gastrotomies were made in porcine explants. One was closed by using endoscopic clips, and the other was closed by using modified T-anchors in a purse-string fashion.


METHODS
Gastric transmural pressure gradients at bursting of these closures were measured while the explanted stomachs were inflated with a high-pressure insufflator.


RESULTS
The mean burst pressure of the looped T-anchors was 27.3 mm Hg, whereas that of the clip closures was 14 mm Hg. By using 10 mm Hg as a threshold for a "secure" closure, 7 of 9 clip closures failed to meet the threshold value, whereas all 9 of the T-anchor closures met or exceeded the threshold value (P = .0023, 2-tailed Fisher exact test).


CONCLUSIONS
Nonsurvival study.


CONCLUSIONS
Looped T-anchors provide a secure gastric closure for natural orifice surgery and are superior to endoscopic clips for this purpose.
Division of Gastroenterology, Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
David J
DJ
Desilets
John R
JR
Romanelli
David B
DB
Earle
Vihar C
VC
Surti
Field F
FF
Willingham
William R
WR
Brugge
D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D011312:Pressure; D013270:Stomach / Q000601:surgery*; D013525:Surgical Instruments; D053441:Suture Anchors; D013552:Swine; D016896:Treatment Outcome