Omentum patch substitute for facilitating endoscopic repair of GI perforations: an early laparoscopic pilot study with a foam matrix plug (with video) - 20/12/12
Reprint requests: Christopher J. Gostout, MD, Developmental Endoscopy Unit, Mayo Clinic, 200 First Street SW, Rochester, MN 55905Résumé |
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.
Design |
Experimental pilot study.
Setting |
Laboratory.
Intervention |
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).
Main Outcome Measurements |
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.
Limitations |
Animal study.
Conclusion |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations : CG, FMP, PG, OP, OPR
Plan
| DISCLOSURE: Biomerix provided and manufactured the prototypes, and Olympus, America, provided the laparoscopic devices. No other financial relationships relevant to this publication were disclosed. |
Vol 77 - N° 1
P. 123-130 - janvier 2013 Retour au numéro
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