title: Gastrojejunal Anastomosis Exclusively Using the "NOTES" Technique in Live Pigs: A Feasibility and Reliability Study.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) could reduce procedure-associated morbidity and mortality. The aim of this study was to determine the feasibility of performing a simple model of gastrojejunal anastomosis in a living porcine model exclusively using NOTES.
  
  
  METHODS
  It was a prospective experimental animal study concerning pigs weighing between 25 and 30 kg. Endoscopies were performed using a double-channel gastroscope. A preliminary phase allowed for the development of the technique on 3 animals that were immediately euthanized. The experimental phase included the implementation of a gastrojejunal anastomosis in 9 animals. Antibiotic therapy was continued for 7 days with gradual feeding. Surviving animals were euthanized after 3 weeks. Anastomosis permeability in each animal was confirmed by opacification, endoscopy, and histopathological analysis. The main outcome measurements were the feasibility and animal survival at 3 weeks postsurgery.
  
  
  RESULTS
  The entire procedure was performed on 9 animals (4 males and 5 females). Anastomosis required 4.7 ± 1.2 stitches (range 4-7). The average total length of the procedure was 143 ± 50.8 minutes (range 87-225 minutes). One bleeding, 2 suture dehiscences, and a poor stomach incision were the immediate complications endoscopically resolved. At 3 weeks, 5 animals had survived. Three animals died as a result of anastomotic leakage confirmed at necropsy and histopathology. In the surviving animals, histology confirmed permeable anastomoses with collagen scar tissue and continuity of the mucosa and mucosa muscle layers.
  
  
  CONCLUSIONS
  Successful gastrojejunal anastomosis by NOTES is technically feasible but is subject to a learning curve.
authors.affiliation: University of Nice Sophia-Antipolis, Nice, France University Hospital of Nice, Nice, France Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France vanbiervliet.g@chu-nice.fr.
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Vanbiervliet
authors.affiliation: Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Gonzalez
authors.affiliation: Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France.
authors.forename: Eduardo Aimore
authors.initials: EA
authors.lastname: Bonin
authors.affiliation: Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Garnier
authors.affiliation: Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Giusiano
authors.affiliation: University of Nice Sophia-Antipolis, Nice, France University Hospital of Nice, Nice, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Saint Paul
authors.affiliation: Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Berdah
authors.affiliation: Laboratoire de Biomécanique Appliquée, UMRT24 IFSTTAR/Aix-Marseille University, France Public Assistance Hospitals of Marseille, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Barthet
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control*; D000818:Animals; D001707:Biopsy, Needle; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D007150:Immunohistochemistry; D007583:Jejunum / Q000473:pathology / Q000601:surgery*; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods* / Q000401:mortality; D010865:Pilot Projects; D015203:Reproducibility of Results; D013270:Stomach / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D034421:Sus scrofa; D013536:Suture Techniques; D013552:Swine; D013718:Tensile Strength
keywords: NOTES; gastric bypass; gastroduodenal stricture; gastrojejunostomy; minimally invasive surgery