Natural orifice transluminal endoscopic surgery for intra-abdominal emergency conditions

Abstract

Background Patient benefits from natural orifice transluminal endoscopic surgery (NOTES) are of interest in acute-care surgery. This review provides an overview of the historical development of NOTES procedures, and addresses their current uses and limitations for intra-abdominal emergency conditions. Methods A PubMed search was carried out for articles describing NOTES approaches for appendicectomy, percutaneous gastrostomy, hollow viscus perforation and pancreatic necrosectomy. Pertinent articles were reviewed and data on available outcomes synthesized. Results Emergency conditions in surgery tax the patient’s cardiovascular and respiratory systems, and fluid and electrolyte balance. The operative intervention itself leads to an inflammatory response and blood loss, thus adding to the physiological stress. NOTES provides a minimally invasive alternative access to the peritoneal cavity, avoiding abdominal wall incisions. A clear advantage to the patient is evident with the implementation of an endoscopic approach to deal with inadvertently displaced percutaneous endoscopic gastrostomy tubes and perforated gastroduodenal ulcer. The NOTES approach appears less invasive for patients with infected pancreatic necrosis, in whom it allows surgical debridement and avoidance of open necrosectomy. Transvaginal appendicectomy is the second most frequently performed NOTES procedure after cholecystectomy. The NOTES concept has provided a change in perspective for intramural and transmural endoscopic approaches to iatrogenic perforations during endoscopy. Conclusion NOTES approaches have been implemented in clinical practice over the past decade. Selected techniques offer reduced invasiveness for patients with intra-abdominal emergencies, and may improve outcomes. Steady future development and adoption of NOTES are likely to follow as technology improves and surgeons become comfortable with the approaches.

Emergency laparotomy at district hospitals in a developing nation: a review of indications and outcomes of treatment

“…Appendix was the most common indication for emergency laparotomy and the most frequent cause of generalized peritonitis in this study. Hitherto, intestinal obstruction from strangulated external hernias was the most frequent indication in the West African subregion, but an epidemiological shift occurred in favor of appendicitis in a manner akin to the Western pattern (9,11,13,16,(27)(28)(29)(30). The reasons adduced included westernization of lifestyle, increased rates of elective repair of external hernia and general improvement in data documentation and access to surgical care in the sub-region (2,11,13,27).…”

Effect of local injection of mesenchymal stem cells on healing of sutured gastric perforation in an experimental model

“…Clinical translation of the promising result of this animal study includes the enhanced healing of gastrotomy wounds after natural‐orifice transgastric endoscopic surgery, or artificial gastric ulcer produced by endoscopic submucosal dissection. As secure gastrotomy closure is extremely important for transgastric endoscopic surgery, application of mesenchymal stem cells by endoscopic injection is a feasible and promising strategy to expedite the healing of a sutured gastrotomy.…”

Emergency surgery in the elderly: the balance between function, frailty, fatality and futility

“…A nomogram including WHO functional status, albumin level and physiological evaluation has been suggested to guide in decision-making [ 44 ]. Notably, several alternative and minimal-invasive strategies can be adopted to handle the acute setting [ 45 - 47 ], sometimes bridging the emergency presentation to an elective and more controlled plan or, even avoiding major interventions at all in order to ensure relief of symptoms when no cure can be provided.…”