title: Comparison of gastrotomy closure modalities for natural orifice transluminal surgery: a canine study.
abstract: BACKGROUND
  Reliable closure of the gastrotomy after transgastric natural orifice transluminal endoscopic surgery (NOTES) remains unresolved.
  
  
  OBJECTIVE
  To compare the technical aspects and clinical and histologic outcomes of NOTES gastrotomy closure techniques.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  Animal laboratory.
  
  
  METHODS
  Thirty-four dogs, 14 for nonsurvival study and 20 for survival study.
  
  
  METHODS
  The animals randomly received different gastrotomy closures after NOTES: endoclip, omentoplasty, over-the-scope-clip (OTSC), and hand-suturing.
  
  
  METHODS
  Procedure time, closure strength, survival, postoperative adverse events, and histologic evaluation of wound healing.
  
  
  RESULTS
  Omentoplasty and OTSC groups needed shorter procedure times and fewer clips than the endoclip group. The endoclip and omentoplasty groups generated similar leakage pressures (34.5 ± 2.6 vs 42.2 ± 4.1 mm Hg, P > .05), both lower than OTSC and hand-suturing groups (81.5 ± 2.1 and 87.0 ± 3.0 mm Hg, respectively, P < .001). Of the 20 animals in the survival study (all 4 groups), only 2 of 6 in the endoclip group were killed prematurely due to sepsis. Necropsy revealed the OTSC group reached a 100% clip retention rate, higher than the endoclip (47.9%) and omentoplasty groups (44.4%, P < .05) rates. Complete healing, defined as intact and continuous gastric layers microscopically, was seen in 83.3% of animals (5 of 6) in the omentoplasty group, comparable with OTSC (4 of 6, 66.7%, P = .500) but higher than the endoclip group (1 of 6, 16.7%, P = .04).
  
  
  CONCLUSIONS
  Animal study.
  
  
  CONCLUSIONS
  Omentoplasty is easier and safer for NOTES gastrotomy closure than endoclips and offers safety profile and efficacy similar to OTSC and hand-suturing.
authors: Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China.
authors: Gang
authors: G
authors: Sun
authors: Yunsheng
authors: Y
authors: Yang
authors: Xiuli
authors: X
authors: Zhang
authors: Wen
authors: W
authors: Li
authors: Yun
authors: Y
authors: Wang
authors: Lanjing
authors: L
authors: Zhang
authors: Ping
authors: P
authors: Tang
authors: Jinyan
authors: J
authors: Kong
authors: Rugang
authors: R
authors: Zhang
authors: Jiangyun
authors: J
authors: Meng
authors: Xiangdong
authors: X
authors: Wang
mesh_terms: D000818:Animals; D004285:Dogs; D005260:Female; D008297:Male; D057605:Natural Orifice Endoscopic Surgery; D009852:Omentum / Q000601:surgery; D061646:Operative Time; D011897:Random Allocation; D018709:Statistics, Nonparametric; D013270:Stomach / Q000502:physiology / Q000601:surgery*; D013525:Surgical Instruments; D013536:Suture Techniques; D058106:Wound Closure Techniques / Q000009:adverse effects / Q000295:instrumentation; D014945:Wound Healing