Cristians Gonzalez1,2, Jung-Myun Kwak1,3, Federico Davrieux1,4, Ryohei Watanabe5,6, Jacques Marescaux1,5, Lee Swanstrom7. 1. IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France. 2. Department of Surgery, Centro Medico de Caracas, Caracas, Venezuela. 3. Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea. 4. DAICIM Foundation, Teaching, Assistance and Research in Minimally Invasive Surgery, Buenos Aires, Argentina. 5. IRCAD/EITS, Institute of Research Against Digestive Cancer, Strasbourg, France. 6. Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan. 7. IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg, France. lee.swanstrom@ihu-strasbourg.eu.
Abstract
BACKGROUND: Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled pyloroplasty as an alternative treatment option for gastric outlet obstruction. METHODS: Under general anesthesia, six pigs (mean weight 33 kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5 mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1 week after intervention. Pyloroplasty was performed using a 5 mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6-8 days, a second evaluation was performed. At the end of the protocol, all animals were euthanized. RESULTS: Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8 mm (4.9-11.6 mm) and 58.6 mm2 (19-107 mm2), respectively. After the procedure, these values increased to 13.41 mm (9.8-17.6 mm) and 147.7 mm2 (76-244 mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. CONCLUSIONS: Hybrid endoluminal stapled pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.
BACKGROUND: Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled pyloroplasty as an alternative treatment option for gastric outlet obstruction. METHODS: Under general anesthesia, six pigs (mean weight 33 kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5 mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1 week after intervention. Pyloroplasty was performed using a 5 mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6-8 days, a second evaluation was performed. At the end of the protocol, all animals were euthanized. RESULTS: Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8 mm (4.9-11.6 mm) and 58.6 mm2 (19-107 mm2), respectively. After the procedure, these values increased to 13.41 mm (9.8-17.6 mm) and 147.7 mm2 (76-244 mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. CONCLUSIONS: Hybrid endoluminal stapled pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.
Authors: Amber L Shada; Christy M Dunst; Radu Pescarus; Emily A Speer; Maria Cassera; Kevin M Reavis; Lee L Swanstrom Journal: Surg Endosc Date: 2015-08-21 Impact factor: 4.584
Authors: Juan P Toro; Nathaniel W Lytle; Ankit D Patel; S Scott Davis; Jennifer A Christie; J Patrick Waring; John F Sweeney; Edward Lin Journal: J Am Coll Surg Date: 2013-12-24 Impact factor: 6.113
Authors: Eran Shlomovitz; Radu Pescarus; Maria A Cassera; Ahmed M Sharata; Kevin M Reavis; Christy M Dunst; Lee L Swanström Journal: Surg Endosc Date: 2014-08-09 Impact factor: 4.584