Abstract
Background: Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the feasibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing.
Methods: After approval of the Animal Ethics Committee, 20 pigs (20 kg) were anticoagulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was created. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior gastric ulcers were mechanically made on each pig by a “lift and cut technique.” Ulcers were observed for at least 1 min for evidence of continued bleeding. First, bleeding ulcers were treated with sclerosing agents (epinephrine and ethanolmine oleate 5%); following sclerotherapy, ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots.
Results: Ulcers created extended into the vascular submucosa and averaged 7 mm in diameter. Bleeding rate was variable, but significant (2 cm3/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerotherapy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement.
Conclusions: It is possible to technically control bleeding ulcers in most cases with a laparoscopic transgastric technique using sclerosing agent and intraluminal sutures. This approach is promising for future human application; also, the intragastric suturing skills developed may be useful for other surgical interventions.
Similar content being viewed by others
References
Kitano S, Kawanaka H, Tomikawa M, et al. (1994) Bleeding from gastric ulcer. Halted by laparoscopic suture ligation. Surg Endosc 8: 405–407
Kitano S, Ueno K, Hashizume M, et al. (1993) Laparoscopic oversewing of a Mallory-Weiss tear with endoscopic guidance. Surg Endosc 7: 445–446
Nyhus, Wastell (1986) Surgery of the stomach and duodenum
Reid DA, Duthie HL, Bransom CJ, Johnson G (1992) Late follow-up of highly selective vagotomy with excision of the ulcer compared with Billroth I gastrectomy for treatment of benign gastric ulcer. Br J Surg 69: 605–607
Sugawa C (1989) Endoscopic diagnosis and treatment of upper gastrointestinal bleeding. Surg Clin North Am 69: 1167–1183
Sugawa C (1990) Injection therapy for the control of bleeding ulcers. Gastrointest Endosc 36: S50-S51
Way L, Legha P, Mori T (1994) Laparoscopic pancreatic cystogastrostomy: the first operation in the new field of intraluminal laparoscopic surgery. Surg Endosc 8(3): 235
Wheatly KE, Dykes PW (1990) Upper gastro-intestinal bleeding. When to operate. Postgrad Med J 66: 926–931
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Potvin, M., Gagner, M. & Pomp, A. Laparoscopic transgastric suturing for bleeding peptic ulcers. Surg Endosc 10, 400–402 (1996). https://doi.org/10.1007/BF00191624
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00191624