Transgastric instrumentation and bacterial contamination of the peritoneal cavity

Narula, Vimal K.; Hazey, Jeffrey W.; Renton, David; Reavis, Kevin M.; Paul, Christopher M.; Hinshaw, Kristen E.; Needleman, Bradley J.; Mikami, Dean J.; Ellison, E. Christopher; Melvin, W. Scott

doi:10.1007/s00464-007-9661-6

Cited by 86 publications

(72 citation statements)

References 12 publications

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“…While our data for abscess was not statistically significant, there appeared to be a trend towards higher rate of infection. Of the cultures that were positive, there was a higher rate of Gram-negative (enteric) This data supports the conclusion of several studies on rodents and humans that found an association between acid suppression and bacterial overgrowth/infection [6][7][8][9]. In a landmark study by Franklin et al, it was found that the previously held notion of a ''sterile'' foregut was challenged by the finding of polymicrobial gastric flora.…”

Section: Discussionsupporting

confidence: 73%

“…Similarly, in two retrospective human studies, the crude odds ratio for development of spontaneous bacterial peritonitis among PPI users versus nonusers ranged from 1.22 to 7.0 [8,13]. A human study by Narula et al found that transgastric instrumentation contaminates the peritoneal cavity and those patients on PPIs have a higher bacterial load compared with nonusers [7]. In this small series of 50 patients, there was no observable adverse clinical outcome as a result of a higher bacterial load; however these patients were all treated with preoperative antibiotics.…”

Section: Discussionmentioning

confidence: 99%

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The impact of proton-pump inhibitors on intraperitoneal sepsis: a word of caution for transgastric NOTES procedures

et al. 2009

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Background During transgastric natural orifice transluminal endoscopic surgery (NOTES), there is an iatrogenic perforation of the gastric wall with leakage of gastric contents into the peritoneal cavity. The aim of this study is to determine the effect of proton-pump inhibitors (PPI) and alterations of gastric pH on infection during transgastric surgery. Methods Thirty 250-g male Sprague-Dawley rats were divided into a study group (SG, n = 15) and a control group (CG, n =15). SG were given 5 mg/kg pantoprazole for 3 days before procedure and another dose 1 h before. CG received saline at similar time points. A mini-laparotomy with gastrotomy was performed. Aspiration of 2.0 cc gastric contents was removed from the stomach and injected into the peritoneal cavity of both groups. Gastric pH and peritoneal pH levels were obtained. Gastric aspirate was sent for culture. White blood cell counts (WBC) were obtained on postoperative days 1, 7, and 14, and C-reactive protein (CRP) levels were obtained on postoperative day 1. At day 14, a necropsy was performed and aerobic and anaerobic cultures of the peritoneal cavity were obtained. Results There were no deaths in either group. The average gastric pH in the SG was 5.13 versus 3.26 (p = 0.03) in the CG. The average peritoneal pH was similar in both groups. The WBC in the SG was 4.5 vs. 3.5 (1,000 cells/ mm) in the CG. There was no elevation in CRP levels in either group. Bacterial cultures were positive in 3/15 (20%) rats in the CG and in 9/15 (60%) in the SG (p = 0.008). Intra-abdominal abscesses were found in 2/15 (13%) rats in the CG and in 5/15 (33%) in the SG (p = 0.08). Conclusions Pretreatment with a PPI resulted in a higher rate of peritoneal bacterial contamination and abscess formation. The acidic environment of the stomach appears to be protective against infection when intraperitoneal contamination occurs as a result of gastrotomy.

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 99%

The impact of proton-pump inhibitors on intraperitoneal sepsis: a word of caution for transgastric NOTES procedures

et al. 2009

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“…The trials summarized in Table 2 suggest the rate of infectious complications could be low. Human trials investigating transgastric instrumentation of the peritoneal cavity do report contamination of the peritoneal cavity, but the contamination was found to be clinically insignificant [17,27,28] . Other adverse events including bleeding and pneumothoraces are significant complications in human thoracoscopic procedures [29,30] .…”

Section: Barriers To Clinical Practicementioning

confidence: 99%

Natural orifice transesophageal thoracoscopic surgery: A review of the current state

Turner

Gee

2010

WJG

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Since the concept of Natural Orifice Translumenal Endoscopic Surgery (NOTES) was introduced, it has continued to gain significantly in popularity and enthu siasm for its potential clinical applications. The ability to perform conventional laparoscopic and thoraco scopic procedures without the creation of scars and perhaps faster and less painful recovery has prompted a worldwide devotion to further this field. While intraabdominal NOTES has rapidly transitioned from animal models to human trials, applying the NOTES concept to perform thoracic procedures has been slower to gain momentum. The goal of this review is to sum marize the current state of transesophageal NOTES thoracoscopy by looking at its potential for diagnostic and therapeutic interventions as well as the challenges in transitioning to human trials.

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“…Группами исследователей под руководством E. Auyang (2009), P. Nau (2010, 2011), M. Nikfarjam (2010) были анализированы серии работ, включав-ших не менее, чем 42 TGC [42,157,159,162]. P. Nau и соавт.…”

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“…Од-нако V. Narula и соавт. [157] сообщили об отсутствии интраабдоминальной инфекции после гастротомии у пациентов, перенесших диагностическую трансга-стральную лапароскопию без предварительной же-лудочной дезактивации.…”

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Cholecystectomy: evolution of laparoscopic approach

Михин¹,

Kuhktenko²,

Доронин³

2015

Endosk. khir.

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Transgastric instrumentation and bacterial contamination of the peritoneal cavity

Abstract: Transgastric instrumentation does contaminate the abdominal cavity but pathogens are clinically insignificant due to species or bacterial load. Patients on PPIs do have an increased bacterial load in the gastric aspirate, with no clinical significant infection.

Cited by 86 publications

References 12 publications

The impact of proton-pump inhibitors on intraperitoneal sepsis: a word of caution for transgastric NOTES procedures

The impact of proton-pump inhibitors on intraperitoneal sepsis: a word of caution for transgastric NOTES procedures

Natural orifice transesophageal thoracoscopic surgery: A review of the current state

Cholecystectomy: evolution of laparoscopic approach

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