Document Detail

Transgastric gastropexy and hiatal hernia repair for GERD under EUS control: a porcine model.
MedLine Citation:
PMID:  14722559     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Endoluminal operations for gastroesophageal reflux currently are limited by the inability to visualize and manipulate structures outside the wall of the gut. This may be possible by using EUS. The aims of this study were the following: to define the EUS anatomy of structures outside the gut that influence reflux, to place stitches in the median arcuate ligament, to perform posterior gastropexy, and to test the feasibility of crural repair under EUS control in pigs. METHODS: In survival experiments in 22 pigs, by using a linear-array echoendoscope, the median arcuate ligament and part of the right crus were identified and punctured with a needle, which served as a carrier for a tag and thread. These were anchored into the muscle. An endoscopic sewing device was used, allowing stitches to be placed through a 2.8-mm accessory channel to any predetermined depth. New methods allowed knot tying and thread cutting through the 2.8-mm channel of the echoendoscope. RESULTS: Stitches were placed through the gastric wall into the median arcuate ligament, and one stitch was placed just beyond the wall of the lower esophageal sphincter. The stitches were tied together and locked against the gastric wall. Median lower esophageal sphincter pressure, determined manometrically, was 11 mm Hg before surgery and 21 mm Hg after stitch placement (p=0.0002). The length of the lower esophageal sphincter increased from a median of 2.8 cm before the procedure to 3.5 cm after the procedure. At the postmortem, the median force required to pull the tags out of the median arcuate ligament was 2.8 kg. CONCLUSIONS: This study demonstrates that transgastric gastroesophageal reflux surgery, by using stitching under EUS control, can significantly increase lower esophageal sphincter pressure in pigs.
Annette Fritscher-Ravens; C Alexander Mosse; Dipankar Mukherjee; Etsuro Yazaki; Per-Ola Park; Tim Mills; Paul Swain
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Gastrointestinal endoscopy     Volume:  59     ISSN:  0016-5107     ISO Abbreviation:  Gastrointest. Endosc.     Publication Date:  2004 Jan 
Date Detail:
Created Date:  2004-01-14     Completed Date:  2004-05-21     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0010505     Medline TA:  Gastrointest Endosc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  89-95     Citation Subset:  IM    
Academic Department of Gastroenterology, The Royal London Hospital-Whitechapel, London, United Kingdom.
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MeSH Terms
Disease Models, Animal
Endoscopy, Gastrointestinal / methods*
Gastroesophageal Reflux / etiology,  surgery*,  ultrasonography
Hernia, Hiatal / complications,  surgery*,  ultrasonography
Suture Techniques*

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