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Loop-anchor purse-string versus endoscopic clips for gastric closure: a natural orifice transluminal endoscopic
David J Desilets1, John R Romanelli, David B Earle
1Division of Gastroenterology, Department of Medicine, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts 01199, USA.
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.