Laparoscopic Technique for Permanent Nonrefluxing Gastrostomy: Experimental Study in Pigs

Purpose: This experimental study tested a modification of the Janeway technique for creation of permanent nonrefluxing gastrostomy performed laparoscopically in pigs. Materials and Methods: Six pigs (Large White-Landrace, mean weight 20 kg) were operated on under general anesthesia. The animals were kept under mechanical ventilation with oxygen and halothane by orotracheal intubation, and their vital functions were monitored continuously. A vascularized isoperistaltic tube was prepared with a flap from the gastric wall at the greater curvature, and a full-thickness tunnel was created on its extension toward the gastric antrum using automatic linear stapling devices (Endo-GIA and Endo-TA). The tunnel provides a unidirectional valvular mechanism at the proximal end of the gastric tube. Patency of the gastrostomy was proved by passing a Nélaton tube through it and draining the gastric contents. Continence was tested by filling the stomach with 5 L of saline through an orogastric tube while measuring intragastric pressure up to values >40 cm H2O. All the animals were sacrificed at the end of the operation, the stomach was removed, and the gastrostomy was examined grossly. Results: All the operations were entirely performed laparoscopically with an average operative time of 45 minutes. All the gastrostomies were patent and continent. No major intraoperative complications occurred. Conclusion: This modification of the Janeway operation for permanent nonrefluxing gastrostomy is feasible with a laparoscopic technique. The gastrostomy is effective in providing continence, as demonstrated by the gastric filling test.