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Comparative Study
. 2009 Oct-Dec;13(4):550-4.
doi: 10.4293/108680809X12589998404362.

Comparison of closure of gastric perforation ulcers with biodegradable lactide-glycolide-caprolactone or omental patches

Marietta J O E Bertleff  1 , Toon Stegmann, Robert S B Liem, Geert Kors, Peter H Robinson, Jean Philippe Nicolai, Johan F Lange
Affiliations
Comparative Study

Comparison of closure of gastric perforation ulcers with biodegradable lactide-glycolide-caprolactone or omental patches

Marietta J O E Bertleff et al. JSLS. 2009 Oct-Dec.

Abstract

Background: The current treatment of perforated peptic ulcers is primary closure, supported by the application of an omental patch. It is difficult and time consuming to perform this procedure by laparoscopic surgery, largely because of the required suturing. It was our aim to develop and test a new method of closure for gastric perforation that is similar in efficacy and safety to a traditional repair. This technique could have utility in laparoscopic repair, as it does not require sutures or mobilization of the omentum.

Method: The new method, called the "stamp" method consists of closure of the perforation by gluing a biodegradable patch made of lactide-glycolide-caprolacton (LGC, Polyganics, B.V. Groningen, The Netherlands) on the outside of the stomach. It was compared with the omental patch procedure. Perforations were made in the stomach of 20 rats and closed by either method (10 rats in each group). The rats were followed for 10 weeks.

Results: No complications were seen in any of the rats. In both groups, histological degradation of the patch by giant cells started at week 2. No signs of inflammation existed in either group. Signs of closure of the mucosa were seen after 2 weeks, and the muscular layer started to regenerate after 8 weeks in both groups.

Conclusion: Results of both methods were similar, which means that treatment of a gastric perforation through the application of a biodegradable patch to the outside of the stomach is a feasible option and might even be an interesting technique for closure of other perforations in the digestive tract.

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Figures

Figure 1.
Figure 1.
Drawing of Graham omentoplasty. A suture runs through the gastric wall first then takes a bit of pedicled omentum and runs back to the other site of the perforation.
Figure 2.
Figure 2.
The stamp method: the biodegradable patch is glued on the outside of the stomach with a 0.25 cm overlap.
Figure 3.
Figure 3.
Week 6. Biodegradable patch (1) covering defect. Patch is covered with a well-organized fibrotic layer (2). Giant cells invading patch (arrow).
Figure 4.
Figure 4.
Week 8. Omentum covering the perforation site (1). The perforation can still be seen in the noncontinuity of the muscle (2).
Figure 5.
Figure 5.
Perforation site at week 6 covered with omentum. New muscle cells start filling up the perforation.
Figure 6.
Figure 6.
Three giant cells invading the “stamp.” Giant cells are filled with small particles of patch material.
Figure 7.
Figure 7.
Young muscle fibers closing the old perforation site. White line is the remaining operative biodegradable patch at week 8.
See this image and copyright information in PMC

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