RESUMEN
BACKGROUND AND AIMS: Obesity is a major pandemic disease. Surgical therapy is highly effective, but its availability will likely be overwhelmed by the burden of the disease. Endoscopic technologies that could reproduce some of the clinical effects of surgery may become part of the treatment armamentarium. A simple transoral restrictive procedure could play a role in first-line surgical management. METHODS: We evaluated the safety and feasibility of transmural suturing using a simple triangulation platform for gastric volume reduction through the creation of multiple double plicatures. RESULTS: Between May and July 2015, 11 obese (body mass index 34.6 ± 2.1 kg/m2) patients (mean age, 36 ± 10 years) underwent gastroplasty through transmural endoscopic sutures (performed using a triangulation platform and an endoscopic stitcher). The median duration of the procedure was 2.00 hours (range, 1.15-3.15 hours) and dramatically decreased after the first 5 cases. No severe adverse events were observed. Mean (standard deviation) weight loss and percentage of excess weight loss were 5.8 kg (2.7%) and 21% (9%) at 1 month (n = 11), 8.8 kg (4.9%) and 33% (22%) at 3 months (n = 10), and 10.9 kg (7.3%) and 41% (33%) at 6 months (n = 10). CONCLUSIONS: Transoral endoscopic gastroplasty performed using a simple triangulation platform and a dedicated suturing device appears to be safe and effective at mid-term follow-up in creating gastric restriction and inducing weight loss in this first-in-humans experience. (Clinical trials registration number: NCT02534662.).
Asunto(s)
Gastroplastia/métodos , Gastroscopía/métodos , Obesidad/cirugía , Técnicas de Sutura/instrumentación , Adulto , Cirugía Bariátrica/instrumentación , Cirugía Bariátrica/métodos , Estudios de Factibilidad , Femenino , Gastroplastia/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias , Seguridad , Resultado del Tratamiento , Pérdida de PesoRESUMEN
Surface tension effects are dominant in miniaturization. Therefore, a lot of capillary forces models have been recently discussed in the literature. The work reported in this paper intends to prove the equivalence between two methods which are very widespread in capillary forces computation at equilibrium: the energetic method based on the derivation of the total interfacial energy and a second method summing both pressure and tension terms obtained from the meniscus profile (based on the Laplace equation). The results are supported by different qualitative arguments, an analytical proof in the case of a prism-plate configuration, numerical simulation, and experiments in the case of two millimetric spheres.