Air and fluid leak tests after NOTES procedures: a pilot study in a live porcine model (with videos).
Gastrointest Endosc
; 68(3): 513-9, 2008 Sep.
Article
em En
| MEDLINE
| ID: mdl-18402950
ABSTRACT
BACKGROUND:
Transluminal access site closure remains a major challenge in natural orifice transluminal endoscopic surgery (NOTES).OBJECTIVE:
Our purpose was to develop in vivo leak tests for evaluation of the integrity of transgastric access closure. SETTINGS Survival experiments on 12 50-kg pigs. DESIGN ANDINTERVENTIONS:
After a standardized transgastric approach to the peritoneal cavity and peritoneoscopy, the gastric wall incision was closed with T-bars (Wilson-Cook Medical, Winston-Salem, NC) deployed on both sides of the incision and then cinched together. Gastrotomy closure was assessed with air and fluid leak tests. The animals were observed for 1 week and then underwent endoscopic evaluation and necropsy. MAIN OUTCOME MEASUREMENTS (1) Leak-proof closure of the gastric wall incision. (2) Gastric incision healing 1 week after the procedure.RESULTS:
The mean intraperitoneal pressure increased 10.7 +/- 3.7 mm Hg during gastric insufflation when the air leak test was performed before closure compared with 0.9 +/- 0.8 mm Hg after transmural closure of the transgastric access site with T-bars (P < .001). Fluid leak tests demonstrated no leakage of liquid contrast from the stomach into the peritoneal cavity after closure. Necropsy in 1 week confirmed completeness of the gastric closure in all animals with full-thickness healing and no spillage of the gastric contents into the peritoneal cavity.LIMITATIONS:
Leak tests were only evaluated on an animal model.CONCLUSIONS:
Fluid and air leak tests are simple techniques to evaluate in vivo the adequacy of the transluminal access site closure after NOTES procedures. Leak-proof gastric closure resulted in adequate tissue approximation and full-thickness healing of the gastric wall incision.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Pneumoperitônio
/
Técnicas de Sutura
/
Gastroscopia
/
Laparoscopia
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Animals
Idioma:
En
Revista:
Gastrointest Endosc
Ano de publicação:
2008
Tipo de documento:
Article
País de afiliação:
Estados Unidos