Peroral transgastric organ resection: a feasibility study in pigs

被引:189
作者
Merrifield, BF
Wagh, MS
Thompson, CC
机构
[1] Brigham & Womens Hosp, Div Gastroenterol, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Boston, MA 02115 USA
关键词
D O I
10.1016/j.gie.2005.11.043
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background: The feasibility of peroral transgastric peritoneoscopy, liver biopsy, and tubal ligation has been demonstrated in prior animal studies. This approach has the potential to reduce postoperative morbidity Objective: To explore the technical challenges and complications of performing a transgastric organ resection. Design: Two-week animal survival study. Interventions: Five female Yorkshire pigs underwent peroral transgastric partial hysterectomy. With the animals under general anesthesia, a sterile esophageal overtube was placed and a gastric antibiotic lavage was performed. Subsequently, a needle-knife and through-the-scope dilating balloon were used to make an anterior gastric wall incision through which a therapeutic gastroscope was advanced into the peritoneal cavity. Endoscopes and instruments previously had been disinfected in a 2.4% glutaraldehyde bath or were disposable. An endoloop and polypectomy snare were used to resect a portion of the uterus, which was removed through the mouth. Gastric incision closure was attempted with endoclips. After 2 weeks of observation, necropsy was performed. Results: Transgastric partial hysterectomy was performed on all 5 animals. One animal became lethargic and febrile, so necropsy was performed on day 4. An incompletely closed gastric incision and Suppurative peritonitis were found. A second animal developed a fever; necropsy performed on day 14 revealed a gastric abscess at the incision site and scattered abdominal pus. No complications were encountered in the 3 remaining animals, and necropsy revealed well-healed gastric incisions and no evidence of peritonitis. Conclusion: Endoscopic transgastric partial hysterectomy is technically feasible in a porcine model. Strict sterility seems mandatory but cannot always be assured. Incomplete closure of the gastric incision may lead to significant complications.
引用
收藏
页码:693 / 697
页数:5
相关论文
共 16 条
[1]  
ENANDER LK, 1979, ACTA CHIR SCAND, V145, P575
[2]  
FAZIO RA, 1982, AM J GASTROENTEROL, V77, P556
[3]  
Friendship RM, 2000, CAN VET J, V41, P925
[4]   COLONOSCOPIC APPENDECTOMY [J].
GAYLORD, SF .
GASTROINTESTINAL ENDOSCOPY, 1981, 27 (03) :203-203
[5]   Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model [J].
Jagannath, SB ;
Kantsevoy, SV ;
Vaughn, CA ;
Chung, SSC ;
Cotton, PB ;
Gostout, CJ ;
Hawes, RH ;
Pasricha, PJ ;
Scorpio, DG ;
Magee, CA ;
Pipitone, LJ ;
Kalloo, AN .
GASTROINTESTINAL ENDOSCOPY, 2005, 61 (03) :449-453
[6]   Flexible transgastric peritoneoscopy: A novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. [J].
Kalloo, AN ;
Kantsevoy, SV ;
Singh, VK ;
Magee, CA ;
Vaughn, CA ;
Hill, SL .
GASTROENTEROLOGY, 2000, 118 (04) :A1039-A1039
[7]   Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity [J].
Kalloo, AN ;
Singh, VK ;
Jagannath, SB ;
Niiyama, H ;
Hill, SL ;
Vaughn, CA ;
Magee, CA ;
Kantsevoy, SV .
GASTROINTESTINAL ENDOSCOPY, 2004, 60 (01) :114-117
[8]  
MAAS LC, 1978, JAMA-J AM MED ASSOC, V240, P248
[9]   Minilaparoscopic appendectomy [J].
Matthews, BD ;
Mostafa, G ;
Harold, KL ;
Kercher, KW ;
Reardon, PR ;
Heniford, BT .
SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES, 2001, 11 (06) :351-355
[10]   Endoscopic partial hysterectomy in a porcine model using a novel per-oral transgastric approach [J].
Merrfield, BF ;
Wagh, MS ;
Thompson, CC .
AMERICAN JOURNAL OF GASTROENTEROLOGY, 2004, 99 (10) :S312-S313