Transgastric Approach Does Not Increase Postoperative Infections or Complications in Swine Uterine Horn Resection

Doubts have been raised versus NOTES surgery concerning intra abdominal infectious complications. The aim of this study was to compare the postoperative course in open, laparoscopic and transgastric surgery, specially concerning infections and postop well being in a randomized porcine survival study.
Methods & Procedures
30 landrace pigs were randomized to open, laparoscopic or NOTES (transgastric) uterine horn resection with a survival time of 4 weeks. All animals were prepared with liquid diet for 2 days and fasted for 12 hours prior to surgery. They received a single dose of prophylactic antibiotics, Cefuroxim, at start of the procedure. No washing of the stomachs was performed in the transgastric group. All surgical procedures were performed by trained surgeons, NOTES operations were performed by trained surgical endoscpists. Open and laparoscopic surgery was performed using standard surgical techniques. Transgastric surgery was performed using the Olympus R-scope together with conventional endoscopic accessories. The gastric access site was closed using TAS T-tags (Ethicon Endosurgery). Peritoneal fluid was sampled for bacterial culture at the time of peritoneal access, prior to closure and at post mortem. The operating time and the postop time till standing up and eating were recorded. During the first postop week temperature and weight were recorded daily. Blood samples were taken every other day during one week and then every week until post mortem. CRP was analysed using porcine specific ELISA.
27 animals survived until euthanised at 4 weeks. Three animals, one from each group, were euthanized earlier; one due to a hoof infection, one omental bleeding, one abdominal wound dehiscence. The operating time was significantly longer in the NOTES-group, mean 124 min versus 35 min for lap surgery and 23 min for open surgery. However, the groups did not differ concerning postop time to standing up or eating, postop temperature or weight-gain.
At post mortem 3/9 animals in the open surgery group had wound infections and 2/9 in the laparoscopic group. No intra abdominal infections were recorded in either group and there was no significant difference in bacterial cultures at any time-point. The CRP was equal prior to surgery and at its conclusion, but at postop day one the NOTES group had significantly lower CRP than open or lap surgery. From day 3 until day 28 no differences were seen.
Despite a long operating time the transgastrically operated animals recovered just as quickly as the other animals and showed no infectious complications. The lower CRP at day 1 indicates a reduced stress response in the NOTES group.

Session: Podium Presentation

Program Number: S038

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