Gastrotomy closure using bioabsorbable plugs in a canine model

Abstract

The repair of gastric perforation commonly involves simple suture closure using an open or laparoscopic approach. An endolumenal approach using prosthetic materials may be beneficial. The role of bioprosthetics in this instance has not been thoroughly investigated, thus the authors evaluated the feasibility of gastric perforation repair using a bioabsorbable device and quantified gross and histological changes at the injury site. Twelve canines were anesthetized and underwent open gastrotomy. A 1-cm-diameter perforation was created in the anterior wall of the stomach and plugged with a bioabsorbable device. Intralumenal pH was recorded. Canines were sacrificed at one, four, six, eight, and 12 weeks. The stomach was explanted followed by gross and histological examination. The injury site was examined. The relative ability of the device to seal the perforation was recorded, as were postoperative changes. Tissue samples were analyzed for gross and microscopic tissue growth and compared to normal gastric tissue in the same animal as an internal control. A scoring system of -2 to +2 was used to measure injury site healing (-2= leak, -1= no leak and minimal ingrowth, 0= physiologic healing, +1= mild hypertrophic tissue, +2= severe hypertrophic tissue). In all canines, the bioprosthesis successfully sealed the perforation without leak under ex vivo insufflation. At one week, the device maintained its integrity but there was no tissue ingrowth. Histological healing score was -1. At 4-12 weeks, gross examination revealed a healed injury site in all animals. The lumenal portion of the plug was completely absorbed. The gross and histological healing score ranged from -1 to +1. The application of a bioabsorbable device results in durable closure of gastric perforation with physiologic healing of the injury site. This method of gastrotomy closure may aid in the evolution of advanced endoscopic approaches to perforation closure of hollow viscera.

Omentum patch substitute for facilitating endoscopic repair of GI perforations: an early laparoscopic pilot study with a foam matrix plug (with video)

“…19,20 A self-expandable metallic vascular occluder has been used successfully experimentally for closure of an access viscerotomy. 21 A biointegrative and absorbable material can avoid a permanent and potentially contaminated foreign body, which may impair healing.…”

Do gastrotomies require repair after endoscopic transgastric peritoneoscopy? A controlled study

“…On histologic examination, there was robust initial ingrowth through 8 weeks and eventual attenuation, possibly reflecting collagen turnover and remodeling at 12 weeks, as would be expected in the accepted time course of wound healing with healthy subjects. 2 Similarly, in a rat gastric perforation model, a porcine-derived small intestine submucosal patch was used successfully for closure in all animals. Histologic examination revealed the patch to be an effective scaffolding agent, as evidenced by early regeneration of normal gastric mucosa at its edges.…”

“…1 In a recent study, we demonstrated that the application of a bioabsorbable plug device resulted in durable closure of gastric perforation with physiologic healing of the injury site in all animals. 2 Other simple closure techniques involve the use of endoscopic clips or loops, although these only offer mucosal reapproximation. 3,4 Full-thickness endoscopic suturing and stapling devices are currently under study and have generally been successful in closing gastrotomies after endoscopic transgastric peritoneoscopy.…”

Natural Orifice Translumenal Endoscopic Surgery: A Critical Review

“…19,20 This eliminated the need for complex tissue manipulation and provided watertight closure with minimal infectious complications. This technique might simplify the process of viscerotomy closure, provided that it is as reliable as a full-thickness tissue approximation.…”