Background
Endoscopic perforations are surgically repaired by using an omentum patch. Omentum
substitutes may have broader applications particularly in certain sites (eg, esophagus).
Objective
Evaluate a self-expandable foam matrix plug as a synthetic omentum substitute for
repairing iatrogenic gastric perforations in a 4-week survival pig model.
Design
Experimental pilot study.
Setting
Laboratory.
Intervention
A laparoscopic plug repair of a 1-cm, full-thickness, gastric perforation was carried
out by using either a polyurethane foam matrix plug (FMP, 8 animals) or an omentum
plug (OP, 6 animals, control group).
Main Outcome Measurements
Follow-up endoscopy was carried out at 1 and 4 weeks. At necropsy, the perforation
site was evaluated for adhesions and histology by using hematoxylin and eosin analysis.
A portion of the implant was sent for bacterial and fungal culture.
Results
All procedures were technically simple and successful. Thirteen animals thrived well
for 4 weeks. One animal from the FMP group died 3 days postoperatively from diffuse
peritonitis because of a misplaced plug. All remaining FMPs were intact at 4 weeks
and colonized with mixed bacteria, except one animal presenting with FMP migration
after 1 week. Histologically, the FMP group had more prominent inflammation and suppuration
as compared with the OP group, all limited to its adjacent tissue.
Limitations
Animal study.
Conclusion
The FMP offered a technically simple and feasible option for repairing iatrogenic
gastric perforations. With effective sealing, the clinical outcome is similar to that
of an omentum patch repair. Migration and inadequate sealing is a concern, which can
lead to peritonitis and sepsis. Further development is needed to improve FMP performance.
Abbreviations:
CG (control (omentum repair) group), FMP (foam matrix plug), PG (plug (foam matrix) group), OP (omentum plug), OPR (omentum patch repair)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
September 17,
2012
Received:
May 8,
2012
Footnotes
DISCLOSURE: Biomerix provided and manufactured the prototypes, and Olympus, America, provided the laparoscopic devices. No other financial relationships relevant to this publication were disclosed.
Identification
Copyright
© 2013 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.
