Loop-anchor purse-string versus endoscopic clips for gastric closure: a natural orifice transluminal endoscopic surgery comparison study using burst pressures

Background

The success of natural orifice surgery depends on a reliable, secure closure of the opening in the gut. Few tests of the integrity of these closures have been published.

Objective

To determine whether a gastrotomy can be closed safely and effectively from within the stomach by using looped T-anchors—a novel, endoscopically placed device.

Design

Head-to-head comparison trial of 2 closure methods in 9 explanted porcine stomachs.

Setting

Animal laboratory.

Intervention

Paired gastrotomies were made in porcine explants. One was closed by using endoscopic clips, and the other was closed by using modified T-anchors in a purse-string fashion.

Main Outcome Measurements

Gastric transmural pressure gradients at bursting of these closures were measured while the explanted stomachs were inflated with a high-pressure insufflator.

Results

The mean burst pressure of the looped T-anchors was 27.3 mm Hg, whereas that of the clip closures was 14 mm Hg. By using 10 mm Hg as a threshold for a “secure” closure, 7 of 9 clip closures failed to meet the threshold value, whereas all 9 of the T-anchor closures met or exceeded the threshold value (P = .0023, 2-tailed Fisher exact test).

Limitation

Nonsurvival study.

Conclusion

Looped T-anchors provide a secure gastric closure for natural orifice surgery and are superior to endoscopic clips for this purpose.

Abbreviations: LAPS, loop-anchor purse-string, NOTES, natural orifice transluminal endoscopic surgery