title: Do gastrotomies require repair after endoscopic transgastric peritoneoscopy? A controlled study.
abstract: 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.
authors.affiliation: Center for Minimally Invasive Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio 43210, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Fix
authors.forename: Kevin
authors.initials: K
authors.lastname: Volt
authors.forename: Jason C
authors.initials: JC
authors.lastname: Roland
authors.forename: Lynn
authors.initials: L
authors.lastname: Happel
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.forename: Theodore J
authors.initials: TJ
authors.lastname: Cios
authors.forename: Vincent
authors.initials: V
authors.lastname: Ho
authors.forename: Alan
authors.initials: A
authors.lastname: Evans
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Narula
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
mesh_terms: 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*