Assessment of Omentoplasty for Gastrotomy Closure after Natural Orifice Transluminal Endoscopic Surgery (NOTES)

Abstract

Purpose: Reliable and effective closure of gastrotomy during natural orifice transluminal endoscopic surgery (NOTES) procedures is extremely important, and novel methods to improve it are still under way. This study aims to evaluate the feasibility of omentoplasty in the closure of gastric defects in NOTES, and assess the efficacy of this procedure by testing for leakage and peritoneal bacterial load in a porcine model. Methods: Four farm pigs (Sus scrofa domesticus) were selected to undergo peritoneoscopy via a transgastric NOTES procedure. Omentoplasty was used for gastrotomy closure in all procedures. Pigs were subsequently euthanized and the gastrotomy site was examined for leakage using a practical novel leakage test. This technique was based on measuring the maximal intra-gastric pressure of a healthy water-filled porcine stomach and then filling the explanted stomachs with water to achieve this pressure. Positive leakage test was defined as the first sign of leakage before achieving the maximal pressure. Peritoneal samples were also taken for cultures. Results: All gastrotomy sites were adequately sealed at necropsy. No evidence of spontaneous leakage was noted. No leaks were observed even after applying manual pressure on the gastric wall. Leakage testing using our method was negative in all four explanted stomachs. On culture, the mean colony forming units (CFU) for the four pigs was 0.8 ±0.9 CFU/ml and the organism grown was coagulase-negative staphylococcus, probably the result of a cross-contamination from skin flora. Conclusion: Omentoplasty proved to be a feasible, effective and promising technique to seal transgastric access in NOTES procedures. It is associated with a negligible risk of leakage and peritoneal bacterial contamination. Larger future studies need to be conducted to confirm our findings.