Natural orifice transluminal endoscopic surgery versus laparoscopic surgery for inadvertent colon injury repair: feasibility, risk of abdominal adhesions, and peritoneal contamination in a porcine survival model

作者：Romagnuolo Joseph^*; Morris John; Palesch Seth; Hawes Robert; Lewin David; Morgan Katherine

来源：Gastrointestinal Endoscopy, 2010, 71(4): 817-823.

DOI：10.1016/j.gie.2009.10.052

Background: Adhesions are common alter conventional surgery; natural orifice transluminal endoscopic surgery (NOTES) avoids peritoneal disruption and may reduce adhesions.
Objectives: To determine whether adhesions (and peritoneal contamination) are less common with NOTES transgastric colon injury and repair (TGCR) than with laparoscopic colon repair (LCR).
Design/Setting: Porcine survival study.
Interventions: After colon preparation and administration of antibiotics, forty 25-kg male pigs were randomly assigned to either TGCR or OCR. TGCR involved an endoscopic gastrotomy (needle-knife plus balloon dilation), CO, pneumoperitoneum, and a 2-cm needle-knife transmural incision of spiral colon. Colotomies were repaired with clips: gastrotomies were closed with clips and a detachable snare.
Main Outcome Measurements: Adhesions were assessed at necropsy at 21 days; biopsy specimens were blindly reviewed. A 9-point adhesion score (density/vascularity, width, and extent) was averaged from 3 reviewers. Peritoneal lavage was sent for cell count and culture.
Results: Two of 20 TGCR pigs died immediately (unrecognized preoperative autopsy-proven pneumonia). The median procedure times were 70.5 and 19.0 minutes for TGCR and LCR, respectively; weight gains were 7.1 and 8.2 kg, respectively. The median adhesion scores were 4.3 and 3.7. respectively (P=.26); subscores were similar (1.9. 1.5, 1.3 vs 1.7, 1.1, 1.0, respectively (P=.3-.6)). Peritoneal lavage bacterial growth is nonsignificantly lower after TGCR than after LCR (38.9%, vs 60.0%, respectively; P=.30); administration of intragastric antibiotics did not decrease contamination. Three TGCR (vs no LCR) pigs had histologic peritonitis.
Limitations: Animal model, colon prepped, injury immediately recognized.
Conclusion: NOTES colon repair is feasible after transmural injury. Adhesions, histologic peritonitis, and contamination were similar to those with laparoscopy and were not helped by intragastric antibiotics. (Gastrointest Endose 2010:71:817-23.)

• 出版日期2010-4