Test subjects were euthanized DAPT secretase at around 2 months after the operation, at which point necropsy was performed by a medical or veterinary pathologist. The durability of the infolded tissue was indicated by the persistence of the original fold geometry. The presence and degree of serosal bonding were noted. In the histopathologic evaluations, connective tissue bridging and angiogenesis were considered indicators of serosa-to-serosa healing. Erosive lesions and inflammatory tissue were noted when present. Tensile testing was performed using Instron tensile testing equipment. The sections of infolded tissue were securely gripped on either side of the fold and pulled apart at a constant rate until failure occurred. The force, displacement, and description of the failure were recorded and imaged.

The authors found that all fastening devices and techniques created durable plication folds, except for the staple-suture combination. Intermittent point failures in serosal apposition occurred in those dogs that had received only 1 row of fasteners. In regions of the fold not containing fasteners, the serosal surfaces had not bonded. The durable plications were stronger than the surrounding tissue, with tissue failures often occurring in the tissues adjacent to the folds, but not within them. In all cases, the presence of a fold indicated the fold was strong enough to withstand the in vivo stresses created within the gastric wall from eating, normal gastric functions, and vomiting (if present). Pathology showed that the plication had healed, and new serosal tissue had bridged the opposing surfaces.

Histologic studies of the bridges showed connective tissue networks and angiogenesis. The authors concluded that the Batimastat durability of the plication is dependent on continuous fixed serosal apposition by the fastening modality at multiple points along the fold, with multiple rows of fasteners, and fastener spacing of less than 2.5cm within a row producing more durable outcomes. 6. Prospective Studies 6.1. Inclusion Criteria An age over 18 years old and BMI > 40 or BMI > 35 accompanied by at least one comorbidity, according to the US National Institute of Health, criteria were applied in the studies of Skrekas et al. [9], Andraos et al. [10], Ramos et al. [11], Brethauer et al. [12], and Pujol-Gebelli et al. [13]. Inclusion criteria were not defined in the original Talebpour publication although minimum BMI was 36. They were also not defined in the Lopez-Corvala et al. study from Mexico [14], in which minimum BMI was 30.