Details

Autor(en) / Beteiligte

• Bergman, Simon, MD, MSc
• Fix, Daniel J., BS
• Volt, Kevin, MD
• Roland, Jason C., MD
• Happel, Lynn, MD
• Reavis, Kevin M., MD
• Cios, Theodore J., BS
• Ho, Vincent, BS
• Evans, Alan, BS
• Narula, Vimal K., MD
• Hazey, Jeffrey W., MD
• Melvin, W. Scott, MD

Titel

Do gastrotomies require repair after endoscopic transgastric peritoneoscopy? A controlled study

Ist Teil von

• Gastrointestinal endoscopy, 2010-05, Vol.71 (6), p.1013-1017

Ort / Verlag

Maryland heights, MO: Mosby, Inc

Erscheinungsjahr

2010

Quelle

MEDLINE

Beschreibungen/Notizen

• Background The optimal method for closing gastrotomies after transgastric instrumentation has yet to be determined. Objective To compare gastrotomy closure with endoscopically delivered bioabsorbable plugs with no closure. Design Prospective, controlled study. Setting Animal laboratory. Subjects Twenty-three dogs undergoing endoscopic transgastric peritoneoscopy between July and August 2007. Interventions Endoscopic anterior wall gastrotomies were performed with balloon dilation to allow passage of the endoscope into the peritoneal cavity. The plug group (n = 12) underwent endoscopic placement of a 4 × 6-cm bioabsorbable mesh plug in the perforation, whereas the no-treatment group (n = 11) did not. Animals underwent necropsy 2 weeks after the procedure. Main Outcome Measurements Complications related to gastrotomy closure, gastric burst pressures, relationship of burst perforation to gastrotomy, and the degree of adhesions and inflammation at the gastrotomy site. Results After the gastrotomy, all dogs survived without any complications. At necropsy, burst pressures were 77 ± 11 mm Hg and 76 ± 15 mm Hg ( P = .9) in the plug group and no-treatment group, respectively. Perforations occurred at the site of the gastrotomy in 2 of 12 animals in the plug group and in none of the 11 dogs in the no-treatment group ( P = .5). Finally, there were minimal adhesions in all dogs (11/11) in the no-treatment group and minimal adhesions in 3 and moderate adhesions or inflammatory masses in 9 of the 12 animals in the plug group ( P = .004). Limitations Small number of subjects, animal model, no randomization. Gastrotomy trauma during short peritoneoscopy may not be applicable to longer procedures. Conclusions After endoscopic gastrotomy, animals that were left untreated did not show any clinical ill effects and demonstrated adequate healing, with fewer adhesions and less inflammation compared with those treated with a bioabsorbable plug.