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.
Desilets
David J
DJ
Division of Gastroenterology, Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
Romanelli
John R
JR
Earle
David B
DB
Surti
Vihar C
VC
Willingham
Field F
FF
Brugge
William R
WR
D000818:Animals; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D011312:Pressure; D013270:Stomach / Q000601:surgery*; D013525:Surgical Instruments; D053441:Suture Anchors; D013552:Swine; D016896:Treatment Outcome