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Endoscopy 2009; 41(2): 154-159
DOI: 10.1055/s-0028-1119465
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic closure of the natural orifice transluminal endoscopic surgery (NOTES) access site to the peritoneal cavity by means of transmural resorbable sutures: an animal survival study

D. von  Renteln1 , A.  Eickhoff2 , G.  Kaehler3 , B.  Riecken1 , K.  Caca1
  • 1Department of Gastroenterology, Medizinische Klinik I, Klinikum Ludwigsburg, Ludwigsburg, Germany
  • 2Department of Gastroenterology, Medizinische Klinik C, Klinikum Ludwigshafen, Ludwigshafen, Germany
  • 3Section Endoscopy, University hospital Mannheim, University of Heidelberg, Germany
Further Information

Publication History

submitted 2 September 2008

accepted after revision 20 November 2008

Publication Date:
12 February 2009 (online)

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Commentaire de travail de D. von Renteln et al., pp. 154Endoscopy 2009; 41(02): 252-252
DOI: 10.1055/s-0032-1306734

Background and study aims: Endoscopic closure of the transgastric access site is still a critical area of active research and development into natural orifice transluminal surgery (NOTES). To date, no endoscopic technique has utilized resorbable transmural sutures for closure of the NOTES gastrostomy.

Material and methods: Endoscopic gastrostomy closure by means of resorbable sutures was performed in ten female domestic pigs in an animal survival study. Peritoneal cavity access was gained through the anterior gastric wall using the percutaneous endoscopic gastrostomy (PEG) technique and an 18-mm balloon dilator. NOTES exploration of the gallbladder and tubal ligation were performed prior to endoscopic gastrostomy closure. Necropsy was performed 3 weeks post procedure.

Results: Mean suturing time was 26 minutes (range 14 – 35 minutes). In total 90 % (9/10) of gastrostomy closures were performed by means of two transmural resorbable sutures. One gastrostomy was closed using a single resorbable suture. One case of gallbladder perforation occurred during peritoneoscopy and the pig was sacrificed due to subsequent peritonitis 2 days after the procedure. All other pigs (9/10) were found to be healthy 3 weeks after the NOTES procedure and were sacrificed as planned per protocol. Of all the 17 sutures that were applied in the remaining nine pigs, 16 (94 %) had been absorbed, releasing the pledgets intraluminally. During laparotomy no signs of injury to adjacent organs were found in any of these nine animals. In 8/10 pigs (80 %) the gastrostomy site did not burst with pressures exceeding 100 mmHg. Two suturing sites did burst at pressures of 57 and 62 mmHg, respectively.

Conclusions: Endoscopic transmural suturing enables rapid and easy placement of leak-proof resorbable sutures and is suitable for closure of the NOTES transgastric access.

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D. von RentelnMD 

Department of Gastroenterology, Hepatology, and Oncology
Klinikum Ludwigsburg

71640 Ludwigsburg
Germany

Fax: 49-7141-9967219

Email: renteln@gmx.net