Division of General Surgery and the Center for Minimally Invasive Surgery, The Ohio State University School of Medicine and Public Health, Columbus, Ohio, USA.
Gastrointest Endosc. 2010 Mar;71(3):485-9. doi: 10.1016/j.gie.2009.09.032. Epub 2009 Dec 8.
Diagnostic transgastric endoscopic peritoneoscopy is a safe model for exploration of the peritoneum. Endoscopic insufflation of the peritoneal cavity has not been validated in humans. We report here our experience with pneumoperitoneum established endoscopically with a laparoscopic insufflator.
Pneumoperitoneum was established with a laparoscopic insufflator through the biopsy channel of the gastroscope. Intra-abdominal pressure was measured with a transfascial Veress needle and compared with endoscopic values. The gastrotomy was used in the creation of the gastric pouch.
Twenty patients undergoing laparoscopic Roux-en-Y gastric bypass participated in the study. Ten had undergone no previous surgery, whereas the other 10 patients had a history of abdominal procedures.
Diagnostic transgastric endoscopic peritoneoscopy was performed through a gastrotomy created endoscopically without laparoscopic visualization.
Diagnostic findings, operating times, and clinical course were recorded.
The average time for transgastric access was 9.6 minutes. This did not vary in patients with previous surgery (P = .3). Endoscopic insufflation was successful in all patients. The mean endoscopic and laparoscopic pressures were 9.80 and 9.75 mm Hg, respectively (P = .9). In no patients were there limitations to visualization of the abdomen. Adhesions were noted in 80% and 10% of patients with and without a history of surgery, respectively (P = .005). There were no complications related to transgastric passage of the endoscope or exploration of the peritoneal cavity.
Although limited by the small sample size in this study, we believe that transgastric access may be considered as an alternative approach to peritoneal insufflation and provides a safe alternative for exploration of the abdomen. Endoscopic insufflation through the biopsy channel by using a laparoscopic insufflator seems to be an effective and safe method for establishing pneumoperitoneum.
诊断性经胃内镜腹膜检查是一种安全的腹膜探查模型。内镜下向腹腔内充气尚未在人体中得到验证。我们在此报告我们使用腹腔镜注气器经胃镜活检通道建立气腹的经验。
通过胃镜的活检通道使用腹腔镜注气器建立气腹。通过经筋膜 Veress 针测量腹腔内压力，并与内镜值进行比较。胃切开术用于创建胃袋。
20 名接受腹腔镜 Roux-en-Y 胃旁路手术的患者参与了这项研究。其中 10 名患者之前没有接受过手术，而另外 10 名患者有腹部手术史。
通过内镜下创建的胃切开术进行诊断性经胃内镜腹膜检查，无需腹腔镜可视化。
记录诊断结果、手术时间和临床过程。
经胃入路的平均时间为 9.6 分钟。在有手术史的患者中没有差异（P =.3）。所有患者内镜充气均成功。平均内镜和腹腔镜压力分别为 9.80 和 9.75mmHg（P =.9）。在没有患者的腹部视野受到限制。有手术史和无手术史的患者分别有 80%和 10%的患者存在粘连（P =.005）。没有与经胃内镜通过或腹腔探查相关的并发症。
尽管本研究的样本量较小，但我们认为经胃入路可被视为一种替代腹膜充气的方法，并为腹部探查提供了一种安全的替代方法。使用腹腔镜注气器通过活检通道进行内镜充气似乎是一种有效且安全的建立气腹的方法。
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