Gastroenteroanastomosis using NOTES-technologies — results of an experimental study

Introduction. Transluminal endoscopic surgery performed through natural orifices can reduce the incidence of complications associated with the surgical procedure and the incidence of postoperative complications. The purpose of this study was to determine the feasibility of performing an experimental gastroenteroanastomosis in a live pig model using NOTES.

Materials and methods. The experimental study was performed on living laboratory models — pigs weighing from 25 to 30 kg. The study’s preliminary phase allowed working out the technique using two animals removed from the experiment after its successful completion. The final phase included the implementation of gastrojejunoanastomosis in six animals with subsequent observation. In three animals, the procedure was performed with laparoscopic assistance using a single-channel video gastroscope. In the other three animals, it was performed without laparoscopy using a two-channel video gastroscope. Antibiotic therapy continued for seven days after surgery. The surviving animals were removed from the experiment after four weeks. Patency of the anastomosis was confirmed by repeated endoscopy and histological analysis of tissues.

Results. All procedures were completed successfully in six animals (three males and three females). The formation of anastomosis required an average of 133.3 ± 43.8 minutes (range, 80–200 minutes). In one animal, bleeding during gastric wall incision was recorded and was stopped by electrocoagulation. One animal died because of an anastomotic leak and peritonitis, confirmed by autopsy. In the five surviving animals, repeated endoscopy demonstrated fully passable anastomoses covered by the mucosa.

Conclusion. Gastrojejunal anastomosis using NOTES technology is technically possible but requires additional study.