Loop-anchor purse-string versus endoscopic clips for gastric closure: a natural orifice transluminal endoscopic surgery comparison study using burst pressures - 23/08/11
Reprint requests: David J. Desilets, MD, PhD, Division of Gastroenterology, Baystate Medical Center, Springfield, MA 01199.Springfield, Massachusetts, USA
Abstract |
Background |
The success of natural orifice surgery depends on a reliable, secure closure of the opening in the gut. Few tests of the integrity of these closures have been published.
Objective |
To determine whether a gastrotomy can be closed safely and effectively from within the stomach by using looped T-anchors—a novel, endoscopically placed device.
Design |
Head-to-head comparison trial of 2 closure methods in 9 explanted porcine stomachs.
Setting |
Animal laboratory.
Intervention |
Paired gastrotomies were made in porcine explants. One was closed by using endoscopic clips, and the other was closed by using modified T-anchors in a purse-string fashion.
Main Outcome Measurements |
Gastric transmural pressure gradients at bursting of these closures were measured while the explanted stomachs were inflated with a high-pressure insufflator.
Results |
The mean burst pressure of the looped T-anchors was 27.3 mm Hg, whereas that of the clip closures was 14 mm Hg. By using 10 mm Hg as a threshold for a “secure” closure, 7 of 9 clip closures failed to meet the threshold value, whereas all 9 of the T-anchor closures met or exceeded the threshold value (P = .0023, 2-tailed Fisher exact test).
Limitation |
Nonsurvival study.
Conclusion |
Looped T-anchors provide a secure gastric closure for natural orifice surgery and are superior to endoscopic clips for this purpose.
Il testo completo di questo articolo è disponibile in PDF.Abbreviations : LAPS, NOTES
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| DISCLOSURES: Baystate Medical Center and Cook Endoscopy have filed a joint patent disclosure on the LAPS device. Wilson-Cook provided engineer support, some laboratory supplies, and device manufacturing support for this project. Olympus provided the endoscopes, the endoscopic clips, and all of the endoscopic video equipment used in this study. The following authors disclosed financial relationships relevant to this publication: D. Desilets has received an unrestricted research grant from Cook Endoscopy in the past. V. C. Surti is an employee of Wilson-Cook. The authors received no salary support from Cook or Olympus, they have no stock or other interests in these companies, and they have no other disclosures. All other authors disclosed no financial relationships relevant to this publication. |
Vol 70 - N° 6
P. 1225-1230 - dicembre 2009 Ritorno al numero
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