Gastrojejunal stomal reduction with the T-tag device in porcine models (with videos)
| Autor: | Edward H. Livingston, Christopher O. Olukoga, Daniel J. Scott, Deborah C. Hogg, Shou-Jiang Tang, David A. Provost |
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| Rok vydání: | 2008 |
| Předmět: |
Reoperation
Gastric pouch medicine.medical_specialty Swine medicine.medical_treatment Gastric bypass Gastric Bypass Video Recording Risk Assessment Sensitivity and Specificity Endoscopy Gastrointestinal Abdominal wall Stoma medicine Animals Radiology Nuclear Medicine and imaging Reduction (orthopedic surgery) Equipment Safety medicine.diagnostic_test business.industry Stomach Gastroenterology Surgical Stomas Anastomosis Roux-en-Y Equipment Design Surgery Endoscopy Disease Models Animal Jejunum Treatment Outcome medicine.anatomical_structure Feasibility Studies Pouch business |
| Zdroj: | Gastrointestinal Endoscopy. 68:132-138 |
| ISSN: | 0016-5107 |
| Popis: | Background Roux-en-Y gastric bypass is the most commonly performed bariatric operation in the United States. Gastrojejunal (GJ) stomal dilatation associated with weight regain is a late complication. Surgical revision is usually required for stomal or pouch reduction. Objective Our purpose was to evaluate the technical feasibility, efficacy, and safety of stomal reduction with endoscopic T-tag devices. Design Prospective nonsurvival studies were conducted in pigs (n = 2, 110 pounds each). Interventions Three GJ stomas were created in each pig through a midline laparotomy by using circular staplers. Endoscopic GJ stomal reduction/revision was performed on these newly created stomas with an Olympus T-tag device. Necropsy was performed to examine the deployed T-tag locations and procedure-related adjacent tissue/organ injury and to assess the effectiveness of stomal reduction. Results Endoscopic stomal revision was performed on 5 stomas with moderate stomal reduction. One GJ stoma could not be accessed easily by endoscopy because of the small size of the gastric pouch. An average of 4 T-tag devices was deployed around each stoma. The procedural time was about 61 ± 12 minutes for each stomal reduction. Overall, 26 of 39 (66.7%) T-bars were deployed in accepted locations. The stomas were reduced from 1.60 ± 0.21 mm × 1.44 ± 0.14 mm to 1.28 ± 0.29 mm × 0.98 ± 0.17 mm and the percentage of stomal reduction was 27.3% ± 13.3%. In the end, a therapeutic gastroscope could not be advanced through the reduced stomas. In 2 stomas, 5 of 39 (12.8%) T-bars injured or attached to the adjacent organs: isolated stomach and abdominal wall. Limitation Nonsurvival pig studies. Conclusions Endoscopic stomal reduction with T-tag device is technically feasible and effective in two thirds of trials. However, it is associated with a small risk of adjacent organ/tissue injury with the current prototype device and deployment method. |
| Databáze: | OpenAIRE |
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