Randomized Multicenter Controlled Study of Endoscopic and Surgical Closure of a 4-cm Gaping Wide Colon Perforation in a Porcine Model

Natural orifice transluminal endoscopic surgery (NOTES)

“…However, the width of the adhesions was significantly less in the NOTES group in comparison with the laparo− scopic surgery and open surgery groups. Raju et al [3] presented interim results of a ran− domized controlled study of endoscopic closure (n = 10) and open surgical closure (n = 10) of a 4− cm colon perforation in a porcine 21−day survival model. Endoscopic closure was performed via a colonoscope using T−tags, with or without endo− clips.…”

“…T−tags are also frequently used for transluminal closure, but these were not included in the Ryou et al ex−vivo comparison. Raju et al [3] (see "Potential advantages") used T−tags, with or without endoclips, to close a colonic perforation in 10 pigs: one pig was euthanized within 1 week due to fecal peritonitis and in another pig an abscess was found at necropsy (after 2 weeks). A 2/10 rate of infectious complications is unacceptably high when considering the introduction of transcolonic procedures in hu− mans.…”

Which parameters might predict complications after natural orifice endoluminal surgery (NOTES)? Results from a randomized comparison with open surgical access in pigs

“…However, one of the most commonly used parameters for infec− tion and inflammation in the human, C−reactive protein does not seem to be very valid as a measure of inflammation in the pig [10,11]. In the framework of a prospective, randomized study in the pig of the endoscopic or open surgical closure of a large iatrogenic transcolonic endoscopic access to the peritoneal cavity [12], we used the same routine tests that would be carried out in the routine postoperative monitoring of patients, including body weight, daily examination, food intake, body tempera− ture, and blood cell counts. The aim of the present study which focuses on a two−center subgroup of animals, with the major− ity of procedures performed by the first author, was to evalu− ate the ability of these parameters to predict potential compli− cations following a NOTES−based as well as an open surgical procedure.…”