Omental Gastrotomy Closure - Model for a NOTES Graham Patch

Abstract

Open or laparoscopic omental patching (Graham patch) is considered a safe and effective treatment for perforated peptic ulcer disease. As the paradigms for definitive ulcer treatment have shifted since the introduction of H.pylori treatment, omental patching is often the only surgical intervention necessary. We wanted to evaluate the feasibility of endoscopic omental patching in the NOTES model. Methods: Five 50 kg Yorkshire Swine underwent endoscopy and anterior wall gastrotomy with a needle knife and balloon dilation followed by 90 minutes of peritoneoscopy. At the conclusion of the peritoneoscopy a patch of omentum was transferred into the gastrotomy and fixed with hemoclips to the gastric mucosa. Swine were fed pig chow on postoperative day 1 and survival assessed at 14 days. The study was approved by the IACUC. Results: All procedures were successfully completed and appeared technically easier than hemoclip gastrotomy closure. One animal succumbed to airway loss in the immediate post-operative period. All other animals survived and thrived to postoperative day 14. At necropsy, all gastrotomy sites were well healed with minimal omental adhesions and no abdominal infections. Conclusion: In this small animal study the endoscopic omental patching using the NOTES concept appeared feasible, safe and effective. Its therapeutic utility for gastrotomies and perforations in humans should be further investigated.