Gastrotomy Healing After Transgastric Peritoneoscopy: A Randomized Study in a Pig Model.
BACKGROUND
Reliable closure and infection prevention are the main barriers for implementation of pure transgastric peritoneoscopy. The primary aim of this study was to assess healing of over the scope clip (OTSC) closed gastrotomies.


METHODS
Pure transgastric peritoneoscopy was performed in 7 pigs. The pigs were randomized to 14 or 28 postoperative days (POD) of follow-up. Decontamination of the access route was performed before instrumentation. A full necropsy was performed. Closure was evaluated with histopathological examination of excised gastrorrhaphies.


RESULTS
Three pigs were allowed 14 POD of follow-up, and 4 pigs were allowed 28 POD of follow-up. Survival was achieved in 6 of the 7 animals; 1 pig was euthanized due to diffuse peritonitis. Based on our definition, full-thickness healing had only been achieved in a single pig allowed 28 POD. With respect to clinical relevancy, full-thickness healing was deemed achieved in 4 of 6 pigs completing follow-up and in all pigs allowed and surviving 28 POD. Access required repeated punctures and the use of several endoscopic instruments.


CONCLUSIONS
Full-thickness healing of the gastrotomy was only found in a single case when adhering to the per protocol definition. Endoscopic ultrasonography-guided access was difficult. It lacks reproducibility and needs refinement. Despite a combined decontamination regimen, infectious complications still occurred.
1 Department of Surgery, Hvidovre Hospital, University of Copenhagen , Hvidovre, Denmark .
Anders Meller
AM
Donatsky
2 Department of Pathology, Roskilde Hospital, University of Copenhagen , Roskilde, Denmark .
Luise
L
Andersen
3 Department of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen , Frederiksberg, Denmark .
Ole Lerberg
OL
Nielsen
4 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen , Copenhagen, Denmark .
Søren
S
Meisner
4 Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen , Copenhagen, Denmark .
Lars Nannestad
LN
Jørgensen
5 Department of Surgery, Herlev Hospital, University of Copenhagen , Herlev, Denmark .
Jacob
J
Rosenberg
5 Department of Surgery, Herlev Hospital, University of Copenhagen , Herlev, Denmark .
Peter
P
Vilmann
D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D011897:Random Allocation; D015203:Reproducibility of Results; D013270:Stomach / Q000601:surgery*; D013552:Swine; D014945:Wound Healing