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Gastrointest Endosc. 2008 Oct;68(4):724-30. doi: 10.1016/j.gie.2008.02.019. Epub 2008 Jun 4.

Endoscopic colotomy closure for natural orifice transluminal endoscopic surgery using a T-fastener prototype in comparison to conventional laparoscopic suture closure.

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  • 1Department of Surgery, University of Missouri-Columbia, Columbia, Missouri 65212, USA.

Abstract

BACKGROUND:

Safe and efficient endoscopic closure of a colotomy is essential for transcolonic peritoneal access or endoscopic full-thickness resection of the colon, if open or laparoscopic surgery is to be avoided.

OBJECTIVE:

To compare the feasibility and safety of colotomy closure with the newly developed Tissue Approximation System (TAS, Ethicon Endo-Surgery, Inc.) to conventional laparoscopic suture closure.

DESIGN:

Prospective randomized survival animal study involving 16 pigs.

SETTING:

University hospital.

INTERVENTIONS:

Pigs were randomized for closure of a 2- to 3-cm full-thickness colotomy with the TAS or with a conventional laparoscopic running suture.

MAIN OUTCOME MEASUREMENTS:

Success of colotomy closure, time of colotomy closure, postoperative infection, and complication rates.

RESULTS:

Colotomies were successfully closed in all animals. Median closure time (range) was 39.5 minutes (25-95 min) in the TAS group and 23 minutes (16-40 min) in the laparoscopic group (P = .0134). There were no postoperative infections or complications.

LIMITATIONS:

Closure with the TAS was performed under laparoscopic vision. There was no control group without closure of the colotomy site.

CONCLUSIONS:

Colotomies are safely closed with the TAS with comparable results to laparoscopic closure. The TAS may serve as a useful tool to close full-thickness colon defects or colotomy sites made for transluminal endoscopic procedures.

PMID:
18534584
[PubMed - indexed for MEDLINE]
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