Totally stapled gastrojejunal anastomosis using hybrid NOTES - single 12 mm trocar approach in acute andsurvival porcine models.

Objective of the study: The aim of this study was to evaluate the feasibility and safety of a totally stapled gastrojejunal anastomosis performed with hybrid NOTES - single 12-mm trans-abdominal trocar approach in a porcine model. Methods and procedures: The procedure was carried out on 10 domestic pigs (7 acute and 3 survival models) of 45 kg using a NOTES? hybrid technique with a gastroscope and a 12-mm Hasson trocar, positioned in the left hypocondrium. At the end of the procedure a mechanical circular 21 mm gastrojejunal anastomosis was performed by inserting the stapler through a small gastrotomy, after enlarging the trocar incision. In 8 pigs it was performed a lateral-lateral gastro-jejunal by-pass, in 2 pigs a Roux-en-Y gastro-jejunal by-pass. Survival models were followed up for 2 weeks and then a gastroscopy and a necropsy were performed to look for complications. Results: In all 10 cases the procedure was completed through a single 3 cm abdominal incision, without intraoperative complications. The mean operation time was 2 hours, and endoscopic investigation showed that the anastomoses were intact, patent and airtight. In survival models no complications were found during follow-up and anastomoses were regular and well-functioning at control. Pigs fed spontaneously in the first postoperative day, and at the end of the follow-up had grown a mean of 2.5 kilograms. Analgesics have been suspended in the second postoperative day. Conclusions based on the results: Totally stapled gastrojejunal anastomosis using a hybrid NOTES - single 12 mm trocar approach is a simple and safe procedure in the porcine model. Further studies are warranted to evaluate the functional and metabolic results of this procedure.