title: Transgastric small bowel resection and anastomosis: a survival study.
abstract: BACKGROUND
  Recently, natural orifice transluminal endoscopic surgery has emerged with new ideas of a transgastric access. The authors have evaluated the possibility of transgastric bowel resection with several modifications. This study aimed to evaluate transgastic small bowel resection using an automated stapling device via an assisting trocar. In a survival experiment, the possible technical problems, medical complications, and safety of the procedure were investigated as well as the postoperative course and follow-up care.
  
  
  METHODS
  The study protocol was submitted to the animal research committee and approved. A total of 13 swine with a body weight of 25 kg (range, 20-46 kg) were investigated and entered into the study. General anesthesia was induced by certified personnel using ketamine, halothan, oxygen, and nitrous oxide. One trocar was used for laparoscopic assistance. A needleknife was used to complete a 1.5-cm-long gastrotomy. The gastroscope was advanced into the peritoneal cavity, and a small bowel loop was identified. Through the second channel of the scope, a coag-grasper was used to dissect the mesentery. A linear stapler was inserted through the assisting trocar, and the resection was performed. Afterward, the bowel ends were reopened, and the stapler was reinserted for a side-to-side anastomosis. The specimen was removed via the stomach. Gastric closure was completed using laparoscopic mini-instruments. All problems were prospectively documented. Follow-up evaluation was performed over 2 weeks. The animals were killed and reopened, and evidence of adhesions, infection, and abscess formation was evaluated.
  
  
  RESULTS
  In this study, 13 female animals with a body weight of 25 kg (range, 20-46 kg) underwent surgery. No mortality or postoperative complications occurred. The animals had stable weight development. After a follow-up period of 2 weeks, the animals were killed. The findings included minor adhesions, no abscess, and no inflammation.
  
  
  CONCLUSIONS
  Transgastric bowel resection with minor laparoscopic assistance is a safe experimental procedure when performed by surgeons with adequate and extensive training. These experimental procedures should be evaluated carefully and critically in clinical practice.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Agaplesion Markus Krankenhaus, Wilhelm Epstein-Strasse 4, 60431, Frankfurt, Germany. Karl-Hermann.Fuchs@fdk.info
authors.forename: Karl-Hermann
authors.initials: KH
authors.lastname: Fuchs
authors.forename: Wolfram
authors.initials: W
authors.lastname: Breithaupt
authors.forename: Thomas
authors.initials: T
authors.lastname: Schulz
authors.forename: Sandor
authors.initials: S
authors.lastname: Ferencz
authors.forename: Gabor
authors.initials: G
authors.lastname: Varga
authors.forename: Georg
authors.initials: G
authors.lastname: Weber
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D004867:Equipment Design; D005260:Female; D020699:Gastroscopes; D007421:Intestine, Small / Q000601:surgery; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D017792:Surgical Stapling / Q000295:instrumentation*; D013552:Swine