Gastrojejunal Anastomosis Exclusively Using the "NOTES" Technique in Live Pigs: A Feasibility and Reliability Study. (August 2014)

• Record Type: Journal Article
• Authors: Vanbiervliet, Geoffroy; Gonzalez, Jean-Michel; Bonin, Eduardo Aimore; Garnier, Emmanuelle; Giusiano, Sophie; Saint Paul, Marie-Christine; Berdah, Stéphane; Barthet, Marc
• Is Part Of: Surgical innovation. Volume 21:Number 4(2014:Aug.)
• Page Start: 409
• Page End: 418
• Publication Date: 2014-08
• Subjects: NOTES -- gastrojejunostomy -- minimally invasive surgery -- gastroduodenal stricture -- gastric bypass; Surgery, Operative -- Periodicals; Endoscopic surgery -- Periodicals; Laparoscopic surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgical Procedures, Minimally Invasive -- Periodicals; Diffusion of Innovation -- Periodicals; Chirurgie opératoire -- Périodiques; Chirurgie endoscopique -- Périodiques; Chirurgie laparoscopique -- Périodiques; 617.91
• DOI: 10.1177/1553350613508016
• Languages: English
• ISSNs: 1553-3506

Abstract

Introduction . Natural orifice transluminal endoscopic surgery (NOTES) could reduce procedure-associated morbidity and mortality. The aim of this study was to determine the feasibility of performing a simple model of gastrojejunal anastomosis in a living porcine model exclusively using NOTES. Methods . It was a prospective experimental animal study concerning pigs weighing between 25 and 30 kg. Endoscopies were performed using a double-channel gastroscope. A preliminary phase allowed for the development of the technique on 3 animals that were immediately euthanized. The experimental phase included the implementation of a gastrojejunal anastomosis in 9 animals. Antibiotic therapy was continued for 7 days with gradual feeding. Surviving animals were euthanized after 3 weeks. Anastomosis permeability in each animal was confirmed by opacification, endoscopy, and histopathological analysis. The main outcome measurements were the feasibility and animal survival at 3 weeks postsurgery. Results . The entire procedure was performed on 9 animals (4 males and 5 females). Anastomosis required 4.7 ± 1.2 stitches (range 4-7). The average total length of the procedure was 143 ± 50.8 minutes (range 87-225 minutes). One bleeding, 2 suture dehiscences, and a poor stomach incision were the immediate complications endoscopically resolved. At 3 weeks, 5 animals had survived. Three animals died as a result of anastomotic leakage confirmed at necropsy and histopathology. In the surviving animals, histology confirmed permeable anastomoses with collagen scar tissue and continuity of the mucosa and mucosa muscle layers. Conclusion . Successful gastrojejunal anastomosis by NOTES is technically feasible but is subject to a learning curve.