Transgastric gastro-jejunal anastomosis by flexible endoscope on a porcine's digestive tract

Introduction: During the past years rapid development of flexible endoscopies opened new possibilities in minimal invasive procedures. With the help of these techniques the exposure, the risk of complications and the healing period of the patient might be reduced. Newest procedure is the transgastric operation with flexible endoscopy. During this intervention the instrument could be led into the abdominal cavity by making an incision on the wall of the stomach. With this technique different interventions can be performed. The primary aim of our study was to examine the technical feasibility and the success of the formation of gastro-jejunal anastomosis. The secondary request was the exploration of the difficulties which should be overcame in order to introduce this method in the everyday usage.

Method: A lifelike biosynthetic model was made from a slaughtered domestic pig's gastrointestinal tract which was fixed onto a plastic frame. Into the stomach two single-channel gastroscopes were inserted. On the wall of the stomach an approximately 3 centimeters wide incision was made with a needle-knife. Through the hole the first jejunum loop was advanced, which was grasped by a foreign body holder, and was retracted into the stomach. Afterwards an incision was made on the jejunum by the electrocoagulator. The open edges of the gastric wall and the jejunum were fixed together with endoclips.

Result: The model was good for practicing without sacrificing any living animal. The anastomosis is technically feasible and was successfully made on biosynthetic porcine model using the transgastric rout. Although the incisions both on the gastric wall and on the jejunum loop were made easily the fixedness of the anastomosis was technically very difficult.

Conclusion: It was revealed that more experiments and the development of new special instruments are needed in order to become able to conduct the anastomosis safely.