• Skip to main content
  • Skip to header right navigation
  • Skip to site footer

Log in
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
www.sages.org

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Awards
    • Who Is SAGES?
    • Leadership
    • Our Mission
    • Advocacy
    • Committees
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Committee Rosters
      • SAGES Past Presidents
  • Meetings
    • SAGES NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2026 Scientific Session Call for Abstracts
      • 2026 Emerging Technology Call for Abstracts
    • CME Claim Form
    • SAGES Past, Present, Future, and Related Meeting Information
    • SAGES Related Meetings & Events Calendar
  • Join SAGES!
    • Membership Application
    • Membership Benefits
    • Membership Types
      • Requirements and Applications for Active Membership in SAGES
      • Requirements and Applications for Affiliate Membership in SAGES
      • Requirements and Applications for Associate Active Membership in SAGES
      • Requirements and Applications for Candidate Membership in SAGES
      • Requirements and Applications for International Membership in SAGES
      • Requirements for Medical Student Membership
    • Member Spotlight
    • Give the Gift of SAGES Membership
  • Patients
    • Join the SAGES Patient Partner Network (PPN)
    • Patient Information Brochures
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find A SAGES Surgeon
  • Publications
    • Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Sustainability in Surgical Practice
    • SAGES Stories Podcast
    • Patient Information Brochures
    • Patient Information From SAGES
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • MesSAGES – The SAGES Newsletter
    • COVID-19 Archive
    • Troubleshooting Guides
  • Education
    • Wellness Resources – You Are Not Alone
    • Avoid Opiates After Surgery
    • SAGES Subscription Catalog
    • SAGES TV: Home of SAGES Surgical Videos
    • The SAGES Safe Cholecystectomy Program
    • Masters Program
    • Resident and Fellow Opportunities
      • MIS Fellows Course
      • SAGES Robotics Residents and Fellows Courses
      • SAGES Free Resident Webinar Series
      • Fluorescence-Guided Surgery Course for Fellows
      • Fellows’ Career Development Course
    • SAGES S.M.A.R.T. Enhanced Recovery Program
    • SAGES @ Cine-Med Products
      • SAGES Top 21 Minimally Invasive Procedures Every Practicing Surgeon Should Know
      • SAGES Pearls Step-by-Step
      • SAGES Flexible Endoscopy 101
    • SAGES OR SAFETY Video Activity
  • Opportunities
    • Fellowship Recognition Opportunities
    • SAGES Advanced Flexible Endoscopy Area of Concentrated Training (ACT) SEAL
    • Multi-Society Foregut Fellowship Certification
    • Research Opportunities
    • FLS
    • FES
    • FUSE
    • Jobs Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • OWLS/FLS
You are here: Home / Abstracts / HYBRID ENDOLUMINAL STAPLED PYLOROPLASTY: AN ALTERNATIVE TREATMENT OPTION FOR GASTRIC OUTLET OBSTRUCTION SYNDROME

HYBRID ENDOLUMINAL STAPLED PYLOROPLASTY: AN ALTERNATIVE TREATMENT OPTION FOR GASTRIC OUTLET OBSTRUCTION SYNDROME

Cristians A Gonzalez, MD1, Jung-Myun Kwak, MD1, Federico Davrieux, MD1, Ryohei Watanabe, MD2, Jacques Marescaux, MD, FACS, HON, FRCS, HON, FJSES, HON, FASA2, Lee L Swanstrom, MD, FACS, FASGE, Hon, FRCS1. 1IHU-Strasbourg, Institute for Image-Guided Surgery (Strasbourg, France), 2IRCAD, Research Institute against Cancer of the Digestive System (Strasbourg, France)

INTRODUCTION: Gastroparesis is a rapidly increasing problem with sometimes devestating patient consequenses. Surgical treatments, particularly laparoscopic pyloroplasty, have recently gained popularity but require general anesthesia, advanced skills and create risk of leaks. Peroral Pyloromyotomy (POP) is a less invasive alternative but is technically demanding and not widely available. We propose an hybrid laparo-endoscopic collaborative approach using a novel gastric access device to allow a endoluminal stapled pyloroplasty as an alternative treatment option for functional gastric outlet obstruction.

METHODS AND PROCEDURES: Under general anesthesia six female pigs (mean weight 33 kg) had endoscopic placement of 2 or 3 5mm intragastric ports (TAGGS, Kansas, USA) using a technique similar to percutaneous endoscopic gastrostomy. A 5mm laparoscope was used for visualization. EndoFLIP (Crospon, Inc., Galway, Ireland) was used to measure cross sectional area (CSA) and compliance of the pylorus before intervention, immediately after and at 1 week survival. Pyloroplasty was performed using a 5mm articulating laparoscopic stapler (Dextera MicroCutter). After removing the TAGGS ports, the gastrotomies were closed by either endoscopic clip, endoscopic suture or suture under laparoscopic vision. The animals were survived for 1 week. After 6-8 days, a second laparo-endoscopic procedure was performed to verify healing of the pyloroplasty as well as intraluminal dimensions. At the end of the protocol, animals were euthanized.

RESULTS: Six endoluminal linear stapled pyloroplasty were performed. The mean operative time was 112 min. In all cases, this technique was effective in achieving optimal pyloric dilatation. Median pyloric diameter (D) and median cross-sectional area (CSA) pre-pyloroplasty were 8mm (4.9-11.6 mm) and 58.6 mm2 (19-107 mm2). After the procedure, these values were increased to 13.41 mm (9.8-17.6 mm) and 147.7 mm2 (76-244 mm2) respectively (p= 0.0152). No intraoperative events were observed, except one case that presented bleeding in the stapling line that merited transfixing suture with laparoscopic instruments. Postoperatively, all animals did well, with an adequate oral intake and without relevant complications. At follow-up endoscopy, all incisions were healed and the pylorus widely patent. There were no significant changes in the EndoFlip values [D: 13.2 mm (10.6-16.1 mm). CSA: 141.3 mm2 (88-204 mm2). p= 0.9372]. At explant, one animal had periampulary inflamation with a serous collection however testing showed no perforation.

CONCLUSION: Hybrid endoluminal stapled pyloroplasty appears a safe and effective treatment for gastroparesis and may be easier to learn and perform than alternatives such as POP and laparoscopic pyloroplasty.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 86777

Program Number: P379

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

50

Share this:

  • Click to share on X (Opens in new window) X
  • Click to share on Facebook (Opens in new window) Facebook
  • Click to share on LinkedIn (Opens in new window) LinkedIn
  • Click to share on Pinterest (Opens in new window) Pinterest
  • Click to share on WhatsApp (Opens in new window) WhatsApp
  • Click to share on Reddit (Opens in new window) Reddit
  • Click to share on Pocket (Opens in new window) Pocket
  • Click to share on Mastodon (Opens in new window) Mastodon
  • Click to share on Threads (Opens in new window) Threads
  • Click to share on Bluesky (Opens in new window) Bluesky

Related


sages_adbutler_leaderboard

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064

1-310-437-0544

[email protected]

Monday – Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Bluesky
  • X
  • Instagram
  • Facebook
  • YouTube

Copyright © 2025 · SAGES · All Rights Reserved

Important Links

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals