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Surgical Endoscopy

, Volume 33, Issue 1, pp 303–308 | Cite as

Hybrid endoluminal stapled pyloroplasty: an alternative treatment option for gastric outlet obstruction syndrome

  • Cristians Gonzalez
  • Jung-Myun Kwak
  • Federico Davrieux
  • Ryohei Watanabe
  • Jacques Marescaux
  • Lee SwanstromEmail author
Endoluminal Surgery
  • 89 Downloads

Abstract

Background

Gastroparesis is a rapidly increasing problem with sometimes devastating consequences. While surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity, they require general anesthesia, advanced skills, and can lead to leaks. Peroral pyloromyotomy is a less invasive alternative; however, this technique is technically demanding and not widely available. We describe a hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow endoluminal stapled pyloroplasty as an alternative treatment option for gastric outlet obstruction.

Methods

Under general anesthesia, six pigs (mean weight 33 kg) underwent endoscopic placement of intragastric ports using a technique similar to percutaneous endoscopic gastrostomy. A 5 mm laparoscope was used for visualization. A functional lumen imagine probe was used to measure the cross-sectional area (CSA) and diameter of the pylorus before, after, and at 1 week after intervention. Pyloroplasty was performed using a 5 mm articulating laparoscopic stapler. Gastrotomies were closed by endoscopic clips, endoscopic suture, or combination. After 6–8 days, a second evaluation was performed. At the end of the protocol, all animals were euthanized.

Results

Six pyloroplasties were performed. In all cases, this technique was effective in achieving significant pyloric dilatation. The median pre-pyloroplasty pyloric diameter (D) and cross-sectional area (CSA) were 8 mm (4.9–11.6 mm) and 58.6 mm2 (19–107 mm2), respectively. After the procedure, these values increased to 13.41 mm (9.8–17.6 mm) and 147.7 mm2 (76–244 mm2), respectively (p = 0.0152). No important intraoperative events were observed. Postoperatively, all animals did well, with adequate oral intake and no relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent.

Conclusions

Hybrid endoluminal stapled pyloroplasty is a feasible, safe, and effective alternative method for the treatment of gastric outlet obstruction syndrome.

Keywords

Gastric emptying Gastroparesis Endoscopy Pyloroplasty Hybrid surgery Laparo-endoscopic collaborative surgery 

Notes

Acknowledgements

The authors are grateful to Sophie Pernot and David Bass for their contributions to the successful implementation of this study.

Compliance with ethical standards

Disclosures

Drs. Cristians Gonzalez, Jung-Myun Kwak, Federico Davrieux, Ryohei Watanabe, Jacques Marescaux and Lee Swanstrom, have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.IHU-StrasbourgInstitute of Image-Guided SurgeryStrasbourgFrance
  2. 2.Department of SurgeryCentro Medico de CaracasCaracasVenezuela
  3. 3.Department of SurgeryKorea University College of MedicineSeoulRepublic of Korea
  4. 4.DAICIM Foundation, Teaching, Assistance and Research in Minimally Invasive SurgeryBuenos AiresArgentina
  5. 5.IRCAD/EITSInstitute of Research Against Digestive CancerStrasbourgFrance
  6. 6.Department of SurgeryToho University Ohashi Medical CenterTokyoJapan

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