Introduction: Natural orifice transluminal endoscopic surgery (NOTES) gastrojejunal anastomosis
(GJA) is a less invasive surgery for bariatric procedures and gastric outlet obstruction.
The aim of this study was to evaluate the feasibility, efficacy, and safety of a pure
NOTES gastrojejunal bypass using an in vivo porcine model.
Material and methods: A prospective study was performed on nine swine. A double-channel scope was used.
The intervention steps were: (i) gastric incision; (ii) peritoneal access; (iii) jejunal
loop selection and mobilization into the stomach; (iv) stoma creation within the gastric
wall and incision; (v) anastomosis suture and pylorus closure using a T-tag prototype.
The animals were assessed clinically for 3 weeks including the weight gain. The patency
of the GJA was assessed at necropsy and a histological analysis was performed.
Results: We successfully performed all the procedures with a mean (standard deviation [SD])
operative time of 108 (26) minutes. We used a mean of 5.55 (1.30) stitches. There
were no intraprocedural adverse events. Five animals survived up till euthanasia at
3 weeks (65 %). These showed a significant difference in weight curves of a loss of
3.2 kg compared with gain of 5.2 kg in a control group. Four pigs died from anastomotic
dehiscence complicated by peritonitis.
Conclusion: Gastrojejunal bypass with a pure NOTES approach is feasible. This procedure is effective,
resulting in a patent anastomosis and a significant weight loss. However, the anastomotic
dehiscence is a major concern because of its mortality rate, and further studies including
improvement of the suturing device and the technique are needed.
