Omentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery procedures (with video)

Xavier Dray, Samuel A. Giday, Jonathan M. Buscaglia, Kathleen L Gabrielson, Sergey V. Kantsevoy, Priscilla Magno, Lia Assumpcao, Eun Shin, Susan K. Reddings, Kevin E. Woods, Michael Marohn, Anthony N Kalloo

Research output: Contribution to journalArticle

Abstract

Introduction: The utility of the greater omentum has not been assessed in transluminal access closure after natural orifice transluminal endoscopic surgery (NOTES) procedures. Objective: Our purpose was to evaluate the feasibility, efficacy, and safety of omentoplasty for gastrotomy closure. Methods and Procedures: Survival experiments in 9 female 40-kg pigs were randomly assigned to 3 groups: group A, endoscopic full-thickness resection (EFTR) for transgastric access and peritoneoscopy without closure; group B, ETFR and peritoneoscopy with omentoplasty (flap of omentum is pulled into the stomach and attached to the gastric mucosa with clips but no clips are used for gastrotomy closure itself); group C, balloon dilation for opening and peritoneoscopy followed by omentoplasty for closure. The animals were observed for 2 weeks and then underwent endoscopy and necropsy with histologic evaluation. Results: Transgastric opening and peritoneoscopy were achieved in all pigs. In groups B and C, a flap of omentum was easily placed to seal the gastrotomy and then attached to the gastric mucosa with 2 to 5 clips (median 4) in 7 to 20 minutes (median 15 minutes). In group A, peritonitis developed in all animals. In both groups B and C, all animals survived 15 days with no peritonitis and minimal adhesions outside the gastrotomy site. In addition, all achieved complete healing (transmural, n = 4; mucosal ulceration, n = 2) of the gastrotomy site. One animal in group B had an 18-mm abscess in the omental flap. Limitations: Animal model, small sample size, lack of appropriate controls for group C. Conclusions: Omentoplasty of the gastrotomy site is a technically feasible method to seal balloon-created transgastric access to the peritoneal cavity after NOTES procedures.

Original languageEnglish (US)
Pages (from-to)131-140
Number of pages10
JournalGastrointestinal Endoscopy
Volume70
Issue number1
DOIs
StatePublished - Jul 2009

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Natural Orifice Endoscopic Surgery
Laparoscopy
Omentum
Surgical Instruments
Gastric Mucosa
Peritonitis
Swine
Peritoneal Cavity
Sample Size
Abscess
Endoscopy
Dilatation
Stomach
Animal Models
Safety
Control Groups

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

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Omentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery procedures (with video). / Dray, Xavier; Giday, Samuel A.; Buscaglia, Jonathan M.; Gabrielson, Kathleen L; Kantsevoy, Sergey V.; Magno, Priscilla; Assumpcao, Lia; Shin, Eun; Reddings, Susan K.; Woods, Kevin E.; Marohn, Michael; Kalloo, Anthony N.

In: Gastrointestinal Endoscopy, Vol. 70, No. 1, 07.2009, p. 131-140.

Research output: Contribution to journalArticle

Dray, Xavier ; Giday, Samuel A. ; Buscaglia, Jonathan M. ; Gabrielson, Kathleen L ; Kantsevoy, Sergey V. ; Magno, Priscilla ; Assumpcao, Lia ; Shin, Eun ; Reddings, Susan K. ; Woods, Kevin E. ; Marohn, Michael ; Kalloo, Anthony N. / Omentoplasty for gastrotomy closure after natural orifice transluminal endoscopic surgery procedures (with video). In: Gastrointestinal Endoscopy. 2009 ; Vol. 70, No. 1. pp. 131-140.
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AU - Dray, Xavier

AU - Giday, Samuel A.

AU - Buscaglia, Jonathan M.

AU - Gabrielson, Kathleen L

AU - Kantsevoy, Sergey V.

AU - Magno, Priscilla

AU - Assumpcao, Lia

AU - Shin, Eun

AU - Reddings, Susan K.

AU - Woods, Kevin E.

AU - Marohn, Michael

AU - Kalloo, Anthony N

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N2 - Introduction: The utility of the greater omentum has not been assessed in transluminal access closure after natural orifice transluminal endoscopic surgery (NOTES) procedures. Objective: Our purpose was to evaluate the feasibility, efficacy, and safety of omentoplasty for gastrotomy closure. Methods and Procedures: Survival experiments in 9 female 40-kg pigs were randomly assigned to 3 groups: group A, endoscopic full-thickness resection (EFTR) for transgastric access and peritoneoscopy without closure; group B, ETFR and peritoneoscopy with omentoplasty (flap of omentum is pulled into the stomach and attached to the gastric mucosa with clips but no clips are used for gastrotomy closure itself); group C, balloon dilation for opening and peritoneoscopy followed by omentoplasty for closure. The animals were observed for 2 weeks and then underwent endoscopy and necropsy with histologic evaluation. Results: Transgastric opening and peritoneoscopy were achieved in all pigs. In groups B and C, a flap of omentum was easily placed to seal the gastrotomy and then attached to the gastric mucosa with 2 to 5 clips (median 4) in 7 to 20 minutes (median 15 minutes). In group A, peritonitis developed in all animals. In both groups B and C, all animals survived 15 days with no peritonitis and minimal adhesions outside the gastrotomy site. In addition, all achieved complete healing (transmural, n = 4; mucosal ulceration, n = 2) of the gastrotomy site. One animal in group B had an 18-mm abscess in the omental flap. Limitations: Animal model, small sample size, lack of appropriate controls for group C. Conclusions: Omentoplasty of the gastrotomy site is a technically feasible method to seal balloon-created transgastric access to the peritoneal cavity after NOTES procedures.

AB - Introduction: The utility of the greater omentum has not been assessed in transluminal access closure after natural orifice transluminal endoscopic surgery (NOTES) procedures. Objective: Our purpose was to evaluate the feasibility, efficacy, and safety of omentoplasty for gastrotomy closure. Methods and Procedures: Survival experiments in 9 female 40-kg pigs were randomly assigned to 3 groups: group A, endoscopic full-thickness resection (EFTR) for transgastric access and peritoneoscopy without closure; group B, ETFR and peritoneoscopy with omentoplasty (flap of omentum is pulled into the stomach and attached to the gastric mucosa with clips but no clips are used for gastrotomy closure itself); group C, balloon dilation for opening and peritoneoscopy followed by omentoplasty for closure. The animals were observed for 2 weeks and then underwent endoscopy and necropsy with histologic evaluation. Results: Transgastric opening and peritoneoscopy were achieved in all pigs. In groups B and C, a flap of omentum was easily placed to seal the gastrotomy and then attached to the gastric mucosa with 2 to 5 clips (median 4) in 7 to 20 minutes (median 15 minutes). In group A, peritonitis developed in all animals. In both groups B and C, all animals survived 15 days with no peritonitis and minimal adhesions outside the gastrotomy site. In addition, all achieved complete healing (transmural, n = 4; mucosal ulceration, n = 2) of the gastrotomy site. One animal in group B had an 18-mm abscess in the omental flap. Limitations: Animal model, small sample size, lack of appropriate controls for group C. Conclusions: Omentoplasty of the gastrotomy site is a technically feasible method to seal balloon-created transgastric access to the peritoneal cavity after NOTES procedures.

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