Prospective evaluation of peritoneal fluid contamination following transabdominal vs. transanal specimen extraction in laparoscopic left-sided colorectal resections

Abstract

Although a higher peritoneal contamination was found in the NOSE procedures, there were no significant differences in clinical outcomes relative to standard approach. Avoiding a minilaparotomy to extract the specimen resulted in a significantly lower postoperative analgesic requirement in the NOSE group.

Laparoscopic resection with natural orifice specimen extraction versus conventional laparoscopy for colorectal disease: a meta-analysis

“…In addition, Senagnore et al [41] showed that patients with a higher BMI were associated with a higher conversion rate to open surgery, longer operation time, higher prevalence of complications, and higher prevalence of anastomotic leakage in laparoscopic colectomy. Due to the effects of the BMI, two included studies [16,26] took BMI ≤30 kg/m 2 and one included study [28] took BMI ≤28 kg/m 2 as inclusion criteria for transanal specimen extraction. Based on the consensus mentioned above, strict and thorough criteria for patient selection for NOSE are expected in the future.…”

“…After reading titles and abstracts, 21 studies were shown to be pertinent. Finally, nine studies [16,[22][23][24][25][26][27][28][29] were found to fit the inclusion criteria after reading the full text (Fig. 1).…”

“…Six studies [16,22,24,[27][28][29] reported the outcome of the pain score between two groups on postoperative day (POD) 1. However, we could not extract or calculate values of the mean and SD from the study of Awad et al [24].…”

“…Recently, several studies have confirmed the safety and feasibility of laparoscopic resection with NOSE for the treatment of colorectal disease [9][10][11][12][13][14][15]. However, conflicting conclusions stating that NOSE may increase the possibility of peritoneal contamination have also been yielded [16,17]. Whether laparoscopy with NOSE is desirable to maximize the benefits of minimally invasive surgery and to minimize the risks of postoperative complications is not known.…”

Natural Orifice Surgery (NOTES)

“…A prospective study of peritoneal fl uid contamination following laparoscopic leftsided resections with and without NOSE demonstrated positive peritoneal cultures in 100 % and 89 % of patients, respectively. Only one of 17 patients in the NOSE group developed an anastomotic leak, and there was no difference in infectious complications between the two groups [ 10 ].…”