LAPAROSCOPIC TRANSGASTRIC SUTURING FOR BLEEDING PEPTIC-ULCERS

Background: Peptic ulcers are a frequent cause of upper G.I. bleeding. Since endoscopic methods may be unsuccessful, we have studied the fea sibility of a new laparoscopic approach on a porcine model to control the bleeding of these ulcers with transgastric suturing. Methods: Afte r approval of the Animal Ethics Committee, 20 pigs (20 kg) were antico agulated with intravenous sodium heparin (400 U/kg), and anesthetized. A nasogastric tube was inserted and a 15 mmHg pneumoperitoneum was cr eated. Two 10-mm trocars and one 5-mm trocar were inserted through the abdominal cavity for laparoscopic guidance of three 7-mm endoluminal trocars inside the stomach through the anterior wall. Two posterior ga stric ulcers were mechanically made on each pig by a ''lift and cut te chnique.'' Ulcers were observed for at least 1 min for evidence of con tinued bleeding, First, bleeding ulcers were treated with sclerosing a gents (epinephrine and ethanolmine oleate 5%); following sclerotherapy , ulcers were sutured intraluminaly with 2-0 silk, with intracorporeal knots. Results: Ulcers created extended into the vascular submucosa a nd averaged 7 mm in diameter, Bleeding rate was variable, but signific ant (2 cm(3)/min) in 40%. It was technically possible to suture these ulcers in 80%. Bleeding was controlled in 95% of cases with sclerother apy and intraluminal sutures. One perforation of the posterior gastric wall occurred and four endoluminal trocars had to be reinserted after dislodgement. Conclusions: It is possible to technically control blee ding ulcers in most cases with a laparoscopic transgastric technique u sing sclerosing agent and intraluminal sutures, This approach is promi sing for future human application; also, the intragastric suturing ski lls developed may be useful for other surgical interventions.