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A RELIABLE AND SAFE GASTROTOMY CLOSURE TECHNIQUE ASSESSED IN SURVIVAL MODELS; SUCCESS OF THE QUEEN’S CLOSURE
L Hookey, V Khokhotva, D Hurlbut, D Jalink, B Bielawska, D Mercer, A Samis
Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario
Aims: Natural Orifice Translumenal Endoscopic Surgery evolution to clinical implementation has been hampered by the lack of a reliable, safe, and easy to implement closure technique for the opening created in accessing the peritoneum. The Queen's Closure uses a combination of endoscopic clips and loop devices to close such defects in the stomach wall.
Methods: Five 30 kg pigs underwent endoscopic transgastric surgery with exploration of the peritoneum. The endoscope was then withdrawn back into the stomach and the closure performed creating a polyp type appearance. Three separate primary endoscopists performed the procedures. The animals were recovered, monitored closely and endoscoped one week post surgery. They were then euthanized at two (n=3) and three (n=2) weeks post surgery with subsequent necroscopy.
Results: The mean procedure time (from intubation of esophagus to withdrawal of endoscope) was 79 minutes (range 45-105) with a mean time of exploration of the peritoneum of 14 minutes (range 8-25). Although we did experience some minor technical problems during the closures, each closure was performed successfully, suggesting that the technique is robust and recoverable. All animals recovered well with no problems with pain, distress or signs of infection. They all resumed feeding one day post operation and gained weight in the recovery period (mean increase 1.9 kg, range 0.3-3.7). At endoscopy, all the closures were intact and only identifiable by a small ulcer with the loops and clips having fallen off. At necroscopy the gastrotomy site was identifiable only by minor adhesions. Histology demonstrated full thickness closure with minimal inflammation.
Conclusions: The Queen's Closure is a reliable and safe technique that provides full thickness gastrotomy closure without any observed complications. It has proven to be transferable knowledge that holds promise for clinical implementation.