Transgastric Endoscopic Peritoneoscopy Does Not Lead to Increased Risk of Infectious Complications

Introduction: As the field of natural orifice transluminal endoscopic surgery (NOTES) develops it remains important to determine the risk of clinically significant bacterial contamination and infectious complications of the peritoneal cavity. We report herein the bacterial contamination of the peritoneum in patients undergoing transgastric endoscopic peritoneoscopy (TEP) during laparoscopic roux-en-y gastric bypass (LRYGB) to perform adhesiolysis and direct trocar placement.
Methods: Under human IRB approval for 40 patients, TEP was performed on LRYGB patients to assist with trocar placement and identification/lysis of intra-abdominal adhesions. TEP was performed in all patients without laparoscopic guidance. Stomach sterilization was not performed. Pre-gastrotomy gastric aspirates and post-gastrotomy peritoneal samples were obtained and cultured for identification and comparison. These results were compared with sterile peritoneal samples from 50 similar LRYGB patients previously studied. Patients were followed for infectious complications.
Results: Thirty-one patients were prospectively studied averaging 45 years of age. Mean operative time was 100.5 minutes, endoscopic time 19.4 minutes and transgastric time 8.1 minutes. Mean bacterial counts from the gastric aspirate were significantly greater compared to the peritoneal samples (3,885,837 vs. 2626 CFU/ml, p

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Program Number: P293

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