Comparison of two gastrostomic methods of natural orifice translumenal endoscopic surgery： an experimental study

Abstract

Objective To compare the operation process, complications and access healing between PEG（percutaneous endoscopic gastostomy）-like approach and needle knife incision in natural orifice translumenal endoscopic surgery （NOTES）. Methods Sixteen dogs were randomly divied into 4 groups （4 dogs per group）, and two1.5 cm in diametre gastostomies （2 cm apart） were performed by PEG-like approach and needle knife incision respectively in each dog＇s anterior wall of stomach. Each gastrostomy was closed by 3 endoclips after the peritoneal exploration. Time consumption for each gastrotomy and complications were recorded. Leakage pressure was measured for the first group （0 day）. The healing of each gastostomy and the peritoneal cavity complications, as well as leakage pressures, were examined for 3 other groups on the 3rd day, 7th day and 14th day after necropsy. Results All experimental animals successfully underwent gastrostomies by PEG-like approach and needle knife incision. Although the time consumption for PEG-like approach was longer than that of needle knife incision （8.4 ± 2. 2 min vs. 5.3 ± 1.5 min, P 〈 0. 05）, the bleeding rate during operation was signifcantly lower （6. 2% vs. 37. 5% , P 〈0. 01）. The average leakage pressures for PEG-like approach and needle knife incision on 0 day, 3rd day and 7th day were 12. 3 ± 2. 3 mmHg vs. 11.4 ± 2. 6 mmHg （P 〉 0. 05）, 32. 4 ± 6.7 mmHg vs. 23.7 ± 7. 7 mmHg （P 〈 0. 05） and 76. 8 ± 9. 6 mmHg vs. 52. 4 ± 8. 8 mmHg （P 〈 0. 05）, respectively. In 14d group, the average leakage pressures for two approaches were both beyond 160 mmHg wihout leakage of the stomach. Gross pathological examination revealed that gastrostomies by PEG-like approach had a better healing than that of needle knife incision at the same time point. No peritoneal bleeding, adjacent organ injury or infection were found during necropy in any survived animals. Conclusion Compared with the needle knife incision, PEG-like approach shows the obvious advantages of greater security and more rapid healing in gastrostomy process in spite of the prolonged time consumption. Key words: Endoscopic surgical procedures; Natural orifice translumenal endoscopic surgery; Percutaneous endoscopic gastostomy; Methods