Buck Lauren, Michalek Joel, Van Sickle Kent, Schwesinger Wayne, Bingener Juliane
Department of Surgery, University of Texas Health Science Center, San Antonio, TX, USA.
J Gastrointest Surg. 2008 Nov;12(11):2010-4. doi: 10.1007/s11605-008-0638-0. Epub 2008 Aug 13.
Natural orifice transluminal endoscopic surgery (NOTES) ventral hernia repair could avoid abdominal wall incisions. The infectious risk for mesh placement is of concern. We compared NOTES with laparoscopic mesh placement.
Thirty-seven swine were randomized to abdominal wall polypropylene mesh placement via NOTES or laparoscopy or NOTES control. All animals received antibiotics and gastric irrigation; the laparoscopy group also received preoperative acid suppression. In the NOTES mesh group, the 2-cm(2) polypropylene mesh was placed using a transgastric transportation device and clipped to the anterior abdominal wall. The control animals underwent endoscopy (no gastrotomy) followed by laparoscopic mesh placement or NOTES only without mesh placement. Necropsy was performed at 14 days.
One NOTES mesh placement was incomplete (endoscope failure). All mesh animals survived to 14 days. At necropsy, significantly more mesh infections were noted in the NOTES mesh versus laparoscopy group (4:11 vs 0:14; p = 0.03). Gastric irrigation reduced the bacterial load significantly in all groups (p < 0.001). Infection was independent of gastric bacterial load. No difference between acid suppressed and non-suppressed animals was seen.
The mesh placement via NOTES is technically feasible but has a high infection rate despite irrigation. Sterile conduits are needed to enable NOTES-type hernia repair with mesh.
经自然腔道内镜手术（NOTES）修复腹疝可避免腹壁切口。放置补片的感染风险令人担忧。我们比较了NOTES与腹腔镜补片放置术。
37头猪被随机分为经NOTES或腹腔镜进行腹壁聚丙烯补片放置组或NOTES对照组。所有动物均接受抗生素治疗和胃灌洗；腹腔镜组还接受术前抑酸治疗。在NOTES补片组，使用经胃输送装置放置2平方厘米的聚丙烯补片，并将其夹在前腹壁上。对照动物接受内镜检查（不进行胃切开术），随后进行腹腔镜补片放置术或仅进行NOTES而不放置补片。在14天时进行尸检。
1例NOTES补片放置未完成（内镜故障）。所有补片动物均存活至14天。尸检时，NOTES补片组的补片感染明显多于腹腔镜组（4:11比0:14；p = 0.03）。胃灌洗显著降低了所有组的细菌载量（p < 0.001）。感染与胃细菌载量无关。抑酸和未抑酸动物之间未见差异。
经NOTES放置补片在技术上是可行的，但尽管进行了灌洗，感染率仍很高。需要无菌通道才能通过NOTES进行带补片的疝修补术。
