Do gastrotomies require repair after endoscopic transgastric peritoneoscopy? A controlled study.
BACKGROUND
The optimal method for closing gastrotomies after transgastric instrumentation has yet to be determined.


OBJECTIVE
To compare gastrotomy closure with endoscopically delivered bioabsorbable plugs with no closure.


METHODS
Prospective, controlled study.


METHODS
Animal laboratory.


METHODS
Twenty-three dogs undergoing endoscopic transgastric peritoneoscopy between July and August 2007.


METHODS
Endoscopic anterior wall gastrotomies were performed with balloon dilation to allow passage of the endoscope into the peritoneal cavity. The plug group (n = 12) underwent endoscopic placement of a 4 x 6-cm bioabsorbable mesh plug in the perforation, whereas the no-treatment group (n = 11) did not. Animals underwent necropsy 2 weeks after the procedure.


METHODS
Complications related to gastrotomy closure, gastric burst pressures, relationship of burst perforation to gastrotomy, and the degree of adhesions and inflammation at the gastrotomy site.


RESULTS
After the gastrotomy, all dogs survived without any complications. At necropsy, burst pressures were 77 +/- 11 mm Hg and 76 +/- 15 mm Hg (P = .9) in the plug group and no-treatment group, respectively. Perforations occurred at the site of the gastrotomy in 2 of 12 animals in the plug group and in none of the 11 dogs in the no-treatment group (P = .5). Finally, there were minimal adhesions in all dogs (11/11) in the no-treatment group and minimal adhesions in 3 and moderate adhesions or inflammatory masses in 9 of the 12 animals in the plug group (P = .004).


CONCLUSIONS
Small number of subjects, animal model, no randomization. Gastrotomy trauma during short peritoneoscopy may not be applicable to longer procedures.


CONCLUSIONS
After endoscopic gastrotomy, animals that were left untreated did not show any clinical ill effects and demonstrated adequate healing, with fewer adhesions and less inflammation compared with those treated with a bioabsorbable plug.
Bergman
Simon
S
Center for Minimally Invasive Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio 43210, USA.
Fix
Daniel J
DJ
Volt
Kevin
K
Roland
Jason C
JC
Happel
Lynn
L
Reavis
Kevin M
KM
Cios
Theodore J
TJ
Ho
Vincent
V
Evans
Alan
A
Narula
Vimal K
VK
Hazey
Jeffrey W
JW
Melvin
W Scott
WS
D020341:Absorbable Implants; D000818:Animals; D002404:Catheterization; D004285:Dogs; D005774:Gastrostomy / Q000009:adverse effects; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019919:Prosthesis Implantation; D013270:Stomach / Q000601:surgery*