Strength of Esophageal Closure Techniques With and Without Tissue Reinforcement

Yeginsu, Ali; Ergin, Makbule; Erkorkmaz, Ünal

doi:10.1007/s00268-007-9084-5

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…In the air leak test, complete inverted closure was observed only in the OTSC group. The principle of surgical suturing is traditionally based on inverted suturing of the serosa-muscle layer, such as the Albert-Lembert suture technique [ 28 , 29 ]. However, even if endoscopic closure using hemoclips (as in PSS) appears endoluminally to be complete defect closure, the state of the serosal side is not well known.…”

Section: Discussionmentioning

confidence: 99%

Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model

et al. 2023

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Background The recently developed endoscopic full-thickness resection technique requires reliable closure. The main closure methods are the purse-string suture (PSS) technique and over-the-scope clip (OTSC) technique; however, basic data on the closure strength of each technique are lacking. This study was performed to compare the closure strengths of these two methods in an ex vivo porcine model. Methods In the traction test, a virtual 5-cm full-thickness closure line was closed by the following six methods three times each: conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture. The primary endpoint was the tension at the starting point of dehiscence, measured in Newtons (N) by an automatic traction machine. In the leak test, a 15-mm gastric full-thickness defect was closed by PSS or OTSC six times each, and the closed stomach was then pressurized in a water container. The primary endpoint was the leak pressure when air bubbles appeared. The secondary endpoints were the procedure time and presence of complete inverted closure. Results The mean tension was 2.16, 3.68, 5.15, 18.30, 19.30, and 62.40 N for conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture, respectively. Complete inverted closure was observed for seromuscular PSS, seromuscular OTSC, and surgical suture. The mean leak pressure was 13.7 and 24.8 mmHg in the PSS and OTSC group, respectively (P < 0.01). The mean procedure time was 541 and 169 s in the PSS and OTSC group, respectively (P < 0.01). Complete inverted closure was observed in OTSC alone. Conclusion The OTSC, which allows complete inverted closure, showed greater closure strength than PSS. Considering the size limitation suitable for single OTSC, a therapeutic strategy for closing the larger size is further warranted.

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Section: Discussionmentioning

confidence: 99%

Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model

et al. 2023

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“…Longitudinal myotomy can be performed at both ends of the perforation to best expose the mucosal edges; this is particularly important in the case of spontaneous rupture of the esophagus, a situation in which the mucosal rent is longer than the muscular tear [22]. The edges of the perforation are trimmed and sutured, in two layers whenever possible [45]. In thoracic and abdominal perforations, an endolumenal suction tube can be placed under digital guidance near the suture line.…”

Section: Suture Of the Perforationmentioning

confidence: 99%

Esophageal perforations

Chirica

Champault

Dray

et al. 2010

Journal of Visceral Surgery

171

166

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The incidence of esophageal perforation (EP) has risen with the increasing use of endoscopic procedures, which are currently the most frequent causes of EP. Despite decades of clinical experience, innovations in surgical technique and advances in intensive care management, EP still represents a diagnostic and therapeutic challenge. EP is a devastating event and mortality hovers close to 20%. Ambiguous presentations leading to misdiagnosis and delayed treatment and the difficulties in management are responsible for the high morbidity and mortality rates. A high variety of treatment options are available ranging from observational medical therapy to radical esophagectomy. The potential role of interventional endoscopy and the use of stents for the treatment of EP seem interesting but remain to be evaluated. Surgical primary repair, with or without reinforcement, is the preferred approach in patients with EP. Prognosis is mainly determined by the cause, the location of the injury and the delay between perforation and initiation of therapy.

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“…In the air leak test, complete inverted closure was observed only in the OTSC group. The principle of surgical suturing is traditionally based on inverted suturing of the serosa-muscle layer, such as the Albert-Lembert suture technique [22] , [23]. However, even if endoscopic closure using hemoclips (as in PSS) appears endoluminally to be complete defect closure, the state of the serosal side is not well known.…”

Section: Discussionmentioning

confidence: 99%

Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model

Matsui

Kobara

Nishiyama

et al. 2022

Preprint

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Background The recently developed endoscopic full-thickness resection technique requires reliable closure. The main closure methods are the purse-string suture (PSS) technique and over-the-scope clip (OTSC) technique; however, basic data on the suture strength of each technique are lacking. This study was performed to compare the suture strengths of these two methods in an ex vivo porcine model. Methods In the traction test, a virtual 5-cm full-thickness suture line was closed by the following six methods three times each: conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture. The primary endpoint was the tension at the starting point of dehiscence, measured in Newtons (N) by an automatic traction machine. In the leak test, a 15-mm gastric full-thickness defect was closed by PSS or OTSC six times each, and the sutured stomach was then pressurized in a water container. The primary endpoint was the leak pressure when air bubbles appeared. The secondary endpoints were the procedure time and presence of complete inverted closure.Results The mean tension was 2.16, 3.68, 5.15, 18.30, 19.30, and 62.40 N for conventional hemoclips, mucosal PSS, seromuscular PSS, mucosal OTSC, seromuscular OTSC, and surgical suture, respectively. Complete inverted closure was observed for seromuscular PSS, seromuscular OTSC, and surgical suture. The mean leak pressure was 13.7 and 24.8 mmHg in the PSS and OTSC group, respectively (P < 0.01). The mean procedure time was 541 and 169 seconds in the PSS and OTSC group, respectively (P < 0.01). Complete inverted closure was observed in OTSC alone.Conclusion The OTSC, which allows complete inverted closure, showed greater suture strength than PSS.

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Strength of Esophageal Closure Techniques With and Without Tissue Reinforcement

Abstract: Each layer of the esophagus significantly contributes to strengthening esophageal wall tension with primary esophageal closure, and reinforcement of the esophageal suture with tissue provides an additional significant increase in the bursting pressure of the esophagus.

Cited by 8 publications

References 20 publications

Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model

Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model

Esophageal perforations

Comparison of purse-string suture versus over-the-scope clip for gastric endoscopic full-thickness closure: traction and leak pressure testing in ex vivo porcine model

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