The recent literature has questioned the infectious risk of natural orifice translumenal endoscopic surgery (NOTES). One important requirement of this technique is the need to minimize the risk of eritoneal contamination.
Our study examines the resultant microbial contamination of the human peritoneum after transgastric and transvaginal cholecystectomy.
Methods and procedures: From April 2007 to September 2009, 22 patients undergoing transgastric (n 11) and transvaginal (n 11) cholecystectomy for non complicated cholelithiasis were prospectively studied as part of a database approved by our Institutional Review Board. Intraoperative samplings of peritoneal fluid were collected before and after transgastric (n=11) and transvaginal (n=6/11) access and sent for anaerobic, aerobic and fungal cultures. Each sample was sent for bacterial colony counts, culture, and identification of species. No gastric decontamination was performed and the vagina was prepped with betadine. All patients received single-shot intraoperative antibiotic prophylaxis. Operative times, clinical course and biological parameters were recorded.
Results: Patients undergoing cholecystectomy had peritoneal exposure after trasngastric access for an average of 150 minutes, versus 113 minutes for patients undergoing transvaginal approach. Two of 11 patients (18%) had evidence of novel bacterial contamination of the peritoneum after transgastric approach (Escherichia Coli and Staph. Coagulase -). No patient had a positive anaerobic culture or fungal culture from the peritoneum in the transvaginal group. Total operative time did not predict peritoneal contamination. No clinically significant infectious complications or leaks were noted at 30-day follow-up.
Conclusions: Prolonged peritoneal exposure to gastric content demonstrates minimal contamination of the abdominal cavity and is without postoperative infectious significance. Transvaginal incision would effectively be a clean portal of entry for NOTES.
Session: Podium Presentation
Program Number: S039