Adhesion formation after peritoneoscopy with liver biopsy in a survival porcine model: comparison of laparotomy, laparoscopy, and transgastric natural orifice transluminal endoscopic surgery (NOTES)

E. Dubcenco; L. Assumpcao; X. Dray; K. L. Gabrielson; D. S. Ruben; L. J. Pipitone; G. Donatelli; D. M. Krishnamurty; J. P. Baker; M. R. Marohn; A. N. Kalloo

doi:10.1055/s-0029-1215229

Endoscopy 2009; 41(11): 971-978
DOI: 10.1055/s-0029-1215229

Original article

Adhesion formation after peritoneoscopy with liver biopsy in a survival porcine model: comparison of laparotomy, laparoscopy, and transgastric natural orifice transluminal endoscopic surgery (NOTES)

E. Dubcenco¹ ^, ² ^, ³ , L. Assumpcao⁴ , X. Dray¹ ^, ⁵ , K. L. Gabrielson⁶ , D. S. Ruben⁶ , L. J. Pipitone⁷ , G. Donatelli¹ ^, ⁸ , D. M. Krishnamurty¹ , J. P. Baker² ^, ³ , M. R. Marohn⁴ , A. N. Kalloo¹

¹Division of Gastroenterology, Johns Hopkins Medicine, Baltimore, Maryland, USA
²St. Michael’s Hospital, Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Canada
³University of Toronto, Toronto, Canada
⁴Department of Surgery, Johns Hopkins Medicine, Baltimore, Maryland, USA
⁵APHP, Hôpital Lariboisière, Département Médico-chirurgical de Pathologie digestive, Paris, France
⁶Department of Molecular and Comparative Pathobiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
⁷Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
⁸P. Stefanini Department of General Surgery, La Sapienza University of Rome, Rome, Italy

Abstract

Background and study aims: Minimizing the invasiveness of operations by using natural orifice transluminal endoscopic surgery (NOTES) may reduce adhesion formation. The aim of the study was to compare rates of adhesion formation after peritoneoscopy with liver biopsy by laparotomy, laparoscopy, and transgastric NOTES.

Materials and methods: Experimental comparative survival study, at a university hospital. using 18 female pigs weighing 35 – 40 kg. Peritoneoscopy with liver biopsy was randomized to one of three groups: laparotomy, laparoscopy, and transgastric NOTES. Preoperative, operative, and postoperative care was standardized. Main outcome measures were: (i) survival and complication rates; (ii) assessment of adhesion formation using the Hopkins Adhesion Formation Score at necropsy (day 14).

Results: 100 % of pigs with laparotomy and 33.3 % with laparoscopy had adhesions compared with 16.7 % who underwent transgastric NOTES. Documented adhesion bands totals for each group were: transgastric NOTES 1; laparoscopy 4; laparotomy 17. Median adhesion formation scores were: laparotomy 2.5 (range 2 – 4), compared with laparoscopy 0.0 (0 – 2), and transgastric NOTES 0.0 (0 – 1) (P < 0.001). Spearman coefficient analysis revealed that correlation between adhesion scores assigned by two investigators was excellent (r = 0.99, P < 0.001, 95 % confidence interval [CI] 0.9978 – 0.9996).

Conclusions: Although this was a short-term study, with a low number of animals, it showed that transgastric NOTES and laparoscopy are associated with statistically significantly lower rates of adhesion formation than open surgery when peritoneoscopy with liver biopsy is performed. Incidence and severity of adhesions were lowest with transgastric NOTES.

Full Text

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A. N. KallooMD

Department of Medicine, Division of Gastroenterology

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Email: akalloo@jhmi.edu