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

Background: The optimal method for closing gastrotomies after transgastric instrumentation has yet to be determined. Objective: To compare gastrotomy closure with endoscopically delivered bioabsorbable plugs with no closure. Design: Prospective, controlled study. Setting: Animal laboratory. Subjects: Twenty-three dogs undergoing endoscopic transgastric peritoneoscopy between July and August 2007. Interventions: Endoscopic anterior wall gastrotomies were performed with balloon dilation to allow passage of the endoscope into the peritoneal cavity. The plug group (n = 12) underwent endoscopic placement of a 4 × 6-cm bioabsorbable mesh plug in the perforation, whereas the no-treatment group (n = 11) did not. Animals underwent necropsy 2 weeks after the procedure. Main Outcome Measurements: Complications related to gastrotomy closure, gastric burst pressures, relationship of burst perforation to gastrotomy, and the degree of adhesions and inflammation at the gastrotomy site. Results: After the gastrotomy, all dogs survived without any complications. At necropsy, burst pressures were 77 ± 11 mm Hg and 76 ± 15 mm Hg (P = .9) in the plug group and no-treatment group, respectively. Perforations occurred at the site of the gastrotomy in 2 of 12 animals in the plug group and in none of the 11 dogs in the no-treatment group (P = .5). Finally, there were minimal adhesions in all dogs (11/11) in the no-treatment group and minimal adhesions in 3 and moderate adhesions or inflammatory masses in 9 of the 12 animals in the plug group (P = .004). Limitations: Small number of subjects, animal model, no randomization. Gastrotomy trauma during short peritoneoscopy may not be applicable to longer procedures. Conclusions: After endoscopic gastrotomy, animals that were left untreated did not show any clinical ill effects and demonstrated adequate healing, with fewer adhesions and less inflammation compared with those treated with a bioabsorbable plug.