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

Area of Science:

• Gastroenterology
• Surgical Innovation
• Endoscopic Procedures

Background:

• Optimal closure methods for gastrotomies after transgastric instrumentation remain undetermined.
• Endoscopic transgastric procedures necessitate effective gastrotomy management strategies.

Purpose of the Study:

• To compare the efficacy of endoscopically delivered bioabsorbable plugs versus no closure for gastrotomies.
• Evaluate outcomes of gastrotomy closure in an animal model.

Main Methods:

• Prospective, controlled animal laboratory study involving 23 dogs undergoing endoscopic transgastric peritoneoscopy.
• Gastrotomies were created and either treated with a bioabsorbable plug or left without closure.
• Outcomes assessed included complications, gastric burst pressures, perforation sites, adhesions, and inflammation at necropsy (2 weeks post-procedure).

Main Results:

• All dogs survived without immediate complications.
• Gastric burst pressures were comparable between the plug group (77 ± 11 mm Hg) and the no-treatment group (76 ± 15 mm Hg).
• The no-treatment group exhibited significantly fewer adhesions and less inflammation (P = .004) compared to the plug group.

Conclusions:

• No closure of endoscopic gastrotomies in this animal model resulted in adequate healing with fewer adverse effects.
• Bioabsorbable plug closure was associated with increased adhesions and inflammation.
• Findings suggest that leaving gastrotomies without closure may be a viable option, warranting further investigation in clinical settings.