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Surgical Endoscopy
Published in: Surgical Endoscopy 7/2011

01-07-2011

Transgastric endoscopic peritoneoscopy does not lead to increased risk of infectious complications

Authors: Vanchad C. Memark, Joel B. Anderson, Peter N. Nau, Nilay Shah, Bradley J. Needleman, Dean J. Mikami, William S. Melvin, Jeffrey W. Hazey

Published in: Surgical Endoscopy | Issue 7/2011

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Abstract

Background

It remains important to determine the risk of bacterial contamination and infectious complications of the peritoneal cavity as it pertains to transgastric natural orifice translumenal endoscopic surgery (NOTES) procedures. The infectious implications of such procedures have been quantified in animal models. This report discusses the infectious risks of transgastric endoscopic peritoneoscopy (TEP) in a human clinical trial.

Methods

Under institutional review board approval, 40 patients scheduled for laparoscopic Roux-en-Y gastric bypass (LRYGB) participated in this study. The TEP procedure was performed without preoperative gastric decontamination and without laparoscopic guidance. Preoperative intravenous antibiotics were given. Saline aspirates were taken from the gastric lumen before endoscopic gastrotomy creation and from the peritoneal cavity after transgastric access. Samples were sent for culture, identification, and bacterial counts. Subgroup analysis was performed on patients taking proton pump inhibitors (PPIs). These data were compared with data for “sterile” peritoneal aspirates from a historical cohort of 50 patients undergoing LRYGB.

Results

The median number of bacteria isolated from the gastric aspirates was 980 colony-forming units (CFU)/ml (n = 40). The median number of bacteria isolated from the peritoneal aspirates was 323 CFU/ml. Cross-contamination from the stomach to the peritoneal cavity was documented in eight cases. No abscesses or anastomotic leaks were recorded. One port-site infection occurred. Subgroup analysis of 15 patients receiving PPIs showed elevated bacterial counts in gastric aspirates and the post-TEP peritoneal samples compared with patients not receiving PPIs (n = 25). This subgroup on PPI’s did not have an increase in infectious complications.

Conclusions

Contamination of the peritoneal cavity does occur with TEP, but this does not lead to an increased risk of infectious complications. Similarly, patients receiving PPIs have an increased gastric bacterial load and increased contamination after TEP but not an increased risk of infectious complications.
Literature
1.
ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery White Paper October 2005 (2006) Gastrointest Endosc 63:199–203
2.
Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Pipitone LJ, Talamini MA, Kalloo AN (2006) Transgastric endoscopic splenectomy: is it possible? Surg Endosc 20:522–525PubMedCrossRef
3.
Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecysteogastric anastomosis (videos). Gastrointest Endosc 61:601–606PubMedCrossRef
4.
Wagh MS, Merrifield BF, Thompson CC (2005) Endoscopic transgastric abdominal exploration and organ resection: initial experience in a porcine model. Clin Gastroenterol Hepatol 3:892–896PubMedCrossRef
5.
Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Scorpio DG, Magee CA, Pipitone LJ, Kalloo AN (2005) Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc 61:449–453PubMedCrossRef
6.
Wagh MS, Merrifield BF, Thompson CC (2006) Survival studies after endoscopic transgastric oophorectomy and tubectomy in a porcine model. Gastrointest Endosc 63:473–478PubMedCrossRef
7.
Kantsevoy SV, Jagannath SB, Niiyama H, Chung SS, Cotton PB, Gostout CJ, Hawes RH, Pasricha PJ, Magee CA, Vaughn CA, Barlow D, Shimonaka H, Kalloo AN (2005) Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 62:287–292
8.
Auyang ED, Hungness ES, Vaziri K, Martin JA, Soper NJ (2009) Human NOTES cholecystectomy: transgastric hybrid technique. Gastrointest Surg 13:1149–1150CrossRef
9.
Buck L, Michalek J, Van Sickle K, Schwesinger W, Bingener J (2008) Cangastric irrigation prevent infection during NOTES mesh placement? J Gastrointest Surg 12:2010–2014PubMedCrossRef
10.
Horgan S, Cullen JP, Talamini MA, Mintz Y, Ferreres A, Jacobsen GR, Sandler B, Bosia J, Savides T, Easter DW, Savu MK, Ramamoorthy SL, Whitcomb E, Agarwal S, Lukacz E, Dominguez G, Ferraina P (2009) Natural orifice surgery: initial clinical experience. Surg Endosc 23:1512–1518PubMedCrossRef
11.
Jacobsen GR, Thompson K, Spivack A, Fischer L, Wong B, Culen J, Bosia J, Whitcomb E, Lucas E, Talamini M, Horgan S (2009) Initial experience with transvaginal incisional hernia repair. Hernia 14:89–91PubMedCrossRef
12.
De Sousa LH, de Sousa JA, de Sousa Filho LH, de Sousa MM, de Sousa VM, de Sousa AP, Zorron R (2009) Totally NOTES (T-NOTES) transvaginal cholecystectomy using two endoscopes: preliminary report. Surg Endosc 23:2550–2555PubMedCrossRef
13.
Zorron R, Maggioni LC, Pombo L, Oliveira AL, Carvalho GL, Filgueiras M (2008) NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc 22:542–547PubMedCrossRef
14.
Narula VK, Hazey JW, Renton DB, Reavis KM, Paul CM, Hinshaw KE, Needleman BJ, Mikami DJ, Ellison EC, Melvin WS (2008) Transgastric instrumentation and bacterial contamination of the peritoneal cavity. Surg Endosc 22:605–611PubMedCrossRef
15.
Narula VK, Happel LC, Volt K, Bergman S, Roland JC, Dettorre R, Renton DB, Reavis KM, Needleman BJ, Mikami KJ, Ellison EC, Melvin WS, Hazey JW (2009) Transgastric endoscopic peritoneoscopy does not require decontamination of the stomach in humans. Surg Endosc 23:1331PubMedCrossRef
16.
Nau P, Anderson J, Yuh B, Muscarella P Jr, Christopher Ellison E, Happel L, Narula VK, Melvin WS, Hazey JW (2010) Diagnostic transgastric endoscopic peritoneoscopy: extension of the initial human trial for staging of pancreatic head masses. Surg Endosc 24:1440–1446PubMedCrossRef
Metadata
Title
Transgastric endoscopic peritoneoscopy does not lead to increased risk of infectious complications
Authors
Vanchad C. Memark
Joel B. Anderson
Peter N. Nau
Nilay Shah
Bradley J. Needleman
Dean J. Mikami
William S. Melvin
Jeffrey W. Hazey
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 7/2011
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-010-1521-0

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