title: Omentum patch substitute for facilitating endoscopic repair of GI perforations: an early laparoscopic pilot study with a foam matrix plug (with video).
abstract: BACKGROUND
  Endoscopic perforations are surgically repaired by using an omentum patch. Omentum substitutes may have broader applications particularly in certain sites (eg, esophagus).
  
  
  OBJECTIVE
  Evaluate a self-expandable foam matrix plug as a synthetic omentum substitute for repairing iatrogenic gastric perforations in a 4-week survival pig model.
  
  
  METHODS
  Experimental pilot study.
  
  
  METHODS
  Laboratory.
  
  
  METHODS
  A laparoscopic plug repair of a 1-cm, full-thickness, gastric perforation was carried out by using either a polyurethane foam matrix plug (FMP, 8 animals) or an omentum plug (OP, 6 animals, control group).
  
  
  METHODS
  Follow-up endoscopy was carried out at 1 and 4 weeks. At necropsy, the perforation site was evaluated for adhesions and histology by using hematoxylin and eosin analysis. A portion of the implant was sent for bacterial and fungal culture.
  
  
  RESULTS
  All procedures were technically simple and successful. Thirteen animals thrived well for 4 weeks. One animal from the FMP group died 3 days postoperatively from diffuse peritonitis because of a misplaced plug. All remaining FMPs were intact at 4 weeks and colonized with mixed bacteria, except one animal presenting with FMP migration after 1 week. Histologically, the FMP group had more prominent inflammation and suppuration as compared with the OP group, all limited to its adjacent tissue.
  
  
  CONCLUSIONS
  Animal study.
  
  
  CONCLUSIONS
  The FMP offered a technically simple and feasible option for repairing iatrogenic gastric perforations. With effective sealing, the clinical outcome is similar to that of an omentum patch repair. Migration and inadequate sealing is a concern, which can lead to peritonitis and sepsis. Further development is needed to improve FMP performance.
authors.affiliation: Developmental Endoscopy Unit, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Bonin
authors.forename: Juliane
authors.initials: J
authors.lastname: Bingener
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rajan
authors.forename: Mary
authors.initials: M
authors.lastname: Knipschield
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gostout
mesh_terms: D000818:Animals; D016099:Endoscopy, Gastrointestinal; D007049:Iatrogenic Disease; D010535:Laparoscopy; D009852:Omentum; D010865:Pilot Projects; D011140:Polyurethanes; D013272:Stomach Diseases / Q000601:surgery*; D013552:Swine; D014741:Video Recording
chemical_list: D011140:Polyurethanes; C028279:polyurethane foam