Loop-anchor purse-string versus endoscopic clips for gastric closure: a natural orifice transluminal endoscopic surgery comparison study using burst pressures

BackgroundThe success of natural orifice surgery depends on a reliable, secure closure of the opening in the gut. Few tests of the integrity of these closures have been published.ObjectiveTo determine whether a gastrotomy can be closed safely and effectively from within the stomach by using looped T-anchors—a novel, endoscopically placed device.DesignHead-to-head comparison trial of 2 closure methods in 9 explanted porcine stomachs.SettingAnimal laboratory.InterventionPaired gastrotomies were made in porcine explants. One was closed by using endoscopic clips, and the other was closed by using modified T-anchors in a purse-string fashion.Main Outcome MeasurementsGastric transmural pressure gradients at bursting of these closures were measured while the explanted stomachs were inflated with a high-pressure insufflator.ResultsThe mean burst pressure of the looped T-anchors was 27.3 mm Hg, whereas that of the clip closures was 14 mm Hg. By using 10 mm Hg as a threshold for a “secure” closure, 7 of 9 clip closures failed to meet the threshold value, whereas all 9 of the T-anchor closures met or exceeded the threshold value (P = .0023, 2-tailed Fisher exact test).LimitationNonsurvival study.ConclusionLooped T-anchors provide a secure gastric closure for natural orifice surgery and are superior to endoscopic clips for this purpose.