Transgastricus gastrojejunalis anastomosis készítése flexibilis endoszkóppal bioszintetikus modellen = Transgastric gastro-jejunal anastomosis with flexible endoscope on a biosynthetic model

Bevezetes: A flexibilis endoszkopia fejlődese az utobbi evekben uj minimalisan invaziv technikakat teremtett, melyek segitsegevel a szovődmenyek eselye csokkenthető, a gyogyulas folyamata felgyorsithato. Az uj modszerek egyike a flexibilis endoszkoppal vegzett transgastricus beavatkozas, melynek soran a gyomor falan ejtett metszesen keresztul a flexibilis eszkoz a hasuregbe vezethető es ott kulonboző beavatkozasok vegezhetők el. Kiserletunk elsődleges celja transgatricus gastrojejunalis anastomosis keszitese es a technikai nehezsegek kimutatasa volt, melyek kikuszobolesevel a kesőbbiekben ez az uj modszer a mindennapokban is alkalmazhato lenne. Modszer: A szerzők hazi sertes gyomor-bel traktusanak (gyomor es első nehany vekonybelkacs) felhasznalasaval elethű bioszintetikus modellt keszitettek, melyet plexilapra rogzitettek. A kiserlet kivitelezesehez ket, egy munkacsatornas endoszkopot hasznaltak. Első lepeskent a gyomorfalon kb. 2 cm-es metszest ejtettek elektrokoagulator es tűpapillotom segitsegevel. A nyilason at az eszkozt atvezetve idegentest-fogoval az első jejunumkacsot megragadtak, a gyomorba huztak, majd a jejunumon is egy metszest ejtettek. A belszeleket endoclipekkel rogzitettek egymashoz. Eredmenyek: A modell – elő allat felhasznalasa nelkul – alkalmasnak bizonyult a gyakorlashoz. Az anastomosis transgastricus uton tortent elkeszitese technikailag kivitelezhető volt. Habar a gyomron es a jejunumon a metszesek konnyen kivitelezhetők voltak, a beavatkozas utan az anastomosist megvizsgalva az nem volt eleg biztonsagosnak tekinthető. Kovetkeztetes: Tovabbi kiserletek es uj eszkozok kifejlesztese szukseges az anastomosis biztonsagos elkeszitesehez. Introduction: In the last few years the rapid development of flexible endoscopies has opened new possibilities in minimal invasive procedures. With the help of these techniques the exposure, the risk of complications and the healing period of the patient might be reduced. One of these procedures is the transgastric intervention. Through an incision on the wall of the stomach, the endoscope could be led into the abdominal cavity, where several interventions can be performed. The aim of the study was to examine the technical feasibility and the success of the formation of gastro-jejunal anastomosis. Meanwhile the difficulties of the method could be explored in order to introduce this method in human use. Method: A lifelike biosynthetic model was made from a slaughtered domestic pig’s gastrointestinal tract (stomach and the first few jejunum loops) which was fixed onto a plastic frame. Two single-channel gastroscopes were inserted into the stomach. On the wall of the stomach an approximately 2 centimetres wide incision was made by the electrocoagulator with a needle-knife. Through it the first jejunum loop was grasped by a foreign-body forceps and then was retracted into the stomach. Subsequently the jejunum loop was held safely with the first endoscope. Parallel to it an incision was made on the jejunum by the electrocoagulator. The authors managed to securely unite the open edges of the gastric wall and the jejunum with endoclips. Result: The model was good for practising. The anastomosis is technically feasible and was successfully made on biosynthetic porcine model using the transgastric route. Although the incisions both on the gastric wall and on the jejunum loop were made easily, the fixing of the anastomosis might be questionable. Conclusion: It was revealed that more experiments and the development of new, special instruments are needed in order to conduct the anastomosis safely.