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Article
Loop-anchor purse-string versus endoscopic clips for gastric closure: A natural orifice transluminal endoscopic surgery comparison study using burst pressures
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  • David Earle, MD, Baystate Health
  • David Desilets, MD, Baystate Health
  • John Romanelli, MD, Baystate Health
Document Type
Article, Peer-reviewed
Publication Date
12-1-2009
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.
Citation Information
Desilets DJ, Romanelli JR, Earle DB, Surti VC, Willingham FF, Brugge WR. Loop-anchor purse-string versus endoscopic clips for gastric closure: A natural orifice transluminal endoscopic surgery comparison study using burst pressures Gastrointest Endosc 2009 Dec;70(6):1225-30.