The Ohio State University Medical Center, Department of Surgery, Columbus, OH 43210-1228, USA.
Surgery. 2011 Jan;149(1):147-52. doi: 10.1016/j.surg.2009.10.060. Epub 2010 Feb 1.
Diagnostic transgastric endoscopic peritoneoscopy has been used to evaluate the abdomen. We present our experience with transgastric endoscopic peritoneoscopy (TEP) to access the peritoneum, direct trocar placement, and perform adhesiolysis without laparoscopic visualization in patients undergoing laparoscopic Roux-en-Y gastric bypass.
Forty patients participated. There are 2 arms to the study. The initial 20 patients underwent pre-insufflation of the abdomen prior to TEP. The second 20 had no pre-insufflation. Ten patients in each arm had no surgical history. The other 10 had previous intra-abdominal procedures. TEP was performed through a gastrotomy created without laparoscopic visualization. Adhesions were visualized and taken down endoscopically prior to trocar placement. Diagnostic findings, operative times, and clinical course were recorded.
Average TEP time was 19 min. Three patients had limited visualization due to intra-abdominal adhesions (2) and omental fat (1). Three of the 20 without and 17 of 20 with a history of intra-abdominal surgery had adhesions visualized endoscopically. Endoscopic adhesiolysis was performed in 1 and 4 patients in these groups respectively. Six occult umbilical hernias, 1 inguinal hernia, and 1 hiatal hernia were noted on endoscopic exploration. There were no complications related to intubation of the stomach, accessing the peritoneum, or endoscopic exploration.
TEP is a safe and accurate means to access the peritoneum, visualize the abdominal wall, perform adhesiolysis, and direct trocar placement without laparoscopic guidance. Safe and reliable gastric closure remains the sole limitation to its clinical use outside of a protocol necessitating a gastrotomy.
诊断性经胃内镜腹膜检查已用于评估腹部。我们介绍了在腹腔镜 Roux-en-Y 胃旁路手术中，在没有腹腔镜可视化的情况下，经胃内镜腹膜检查（TEP）进入腹膜、直接套管针放置和进行粘连松解的经验。
40 名患者参与了这项研究。该研究有两个分支。最初的 20 名患者在 TEP 前进行了腹部预充气。第二组 20 名患者没有预充气。每组有 10 名患者没有手术史。另外 10 名患者有腹部手术史。TEP 通过不使用腹腔镜可视化的胃造口术进行。在套管针放置前，通过内镜观察粘连并进行松解。记录诊断结果、手术时间和临床过程。
TEP 的平均时间为 19 分钟。由于腹腔内粘连（2 例）和网膜脂肪（1 例），有 3 名患者的视野有限。20 名无腹腔手术史的患者中有 3 名、20 名有腹腔手术史的患者中有 17 名内镜下观察到粘连。在这些组中，分别有 1 名和 4 名患者进行了内镜粘连松解术。在经内镜探查时，发现了 6 个隐匿性脐疝、1 个腹股沟疝和 1 个食管裂孔疝。与胃插管、进入腹膜或内镜探查相关的并发症。
TEP 是一种安全、准确的进入腹膜、观察腹壁、进行粘连松解和直接套管针放置的方法，无需腹腔镜引导。安全可靠的胃闭合仍然是其在不需要胃造口术的协议之外临床应用的唯一限制。
