Philip C Müller1, Jonas D Senft2, Philip Gath2, Daniel C Steinemann2, Felix Nickel2, Adrian T Billeter2, Beat P Müller-Stich2, Georg R Linke2,3. 1. Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. philip.mueller@hotmail.com. 2. Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. 3. Department of Surgery, Hospital STS Thun AG, Krankenhausstrasse 12, 3600, Thun, Switzerland.
Abstract
BACKGROUND AND STUDY AIMS: The risk of infectious complications due to peritoneal contamination is a major concern and inhibits the widespread use of transrectal NOTES. A standardized rectal washout with a reversible colon occlusion device in situ has previously shown potential in reducing peritoneal contamination. The aim of this study was to compare the peritoneal contamination rate and inflammatory reaction for transrectal cholecystectomy after ideal rectal preparation (trCCE) and standard laparoscopic cholecystectomy (lapCCE) in a porcine survival experiment. METHODS: Twenty pigs were randomized to trCCE (n = 10) or lapCCE (n = 10). Before trCCE, rectal washout was performed with saline solution. A colon occlusion device was then inserted and a second washout with povidone-iodine was performed. The perioperative course and the inflammatory reaction (leukocytes, C-reactive protein) were compared. At necropsy, 14 days after surgery the abdominal cavity was screened for infectious complications and peritoneal swabs were obtained for comparison of peritoneal contamination. RESULTS: Peritoneal contamination was lower after trCCE than after lapCCE (0/10 vs. 6/10; p = 0.003). No infectious complications were found at necropsy in either group and postoperative complications did not differ (p = 1.0). Immediately after the procedure, leukocytes were higher after lapCCE (17.0 ± 2.7 vs. 14.6 ± 2.3; p = 0.047). Leukocytes and C-reactive protein showed no difference in the further postoperative course. Intraoperative complications and total operation time (trCCE 114 ± 32 vs. 111 ± 27 min; p = 0.921) did not differ, but wound closure took longer for trCCE (31.5 ± 19 vs. 13 ± 5 min; p = 0.002). CONCLUSIONS: After standardized rectal washout with a colon occlusion device in situ, trCCE was associated without peritoneal contamination and without access-related infectious complications. Based on the findings of this study, a randomized controlled clinical study comparing clinical outcomes of trCCE with lapCCE should be conducted.
BACKGROUND AND STUDY AIMS: The risk of infectious complications due to peritoneal contamination is a major concern and inhibits the widespread use of transrectal NOTES. A standardized rectal washout with a reversible colon occlusion device in situ has previously shown potential in reducing peritoneal contamination. The aim of this study was to compare the peritoneal contamination rate and inflammatory reaction for transrectal cholecystectomy after ideal rectal preparation (trCCE) and standard laparoscopic cholecystectomy (lapCCE) in a porcine survival experiment. METHODS: Twenty pigs were randomized to trCCE (n = 10) or lapCCE (n = 10). Before trCCE, rectal washout was performed with saline solution. A colon occlusion device was then inserted and a second washout with povidone-iodine was performed. The perioperative course and the inflammatory reaction (leukocytes, C-reactive protein) were compared. At necropsy, 14 days after surgery the abdominal cavity was screened for infectious complications and peritoneal swabs were obtained for comparison of peritoneal contamination. RESULTS: Peritoneal contamination was lower after trCCE than after lapCCE (0/10 vs. 6/10; p = 0.003). No infectious complications were found at necropsy in either group and postoperative complications did not differ (p = 1.0). Immediately after the procedure, leukocytes were higher after lapCCE (17.0 ± 2.7 vs. 14.6 ± 2.3; p = 0.047). Leukocytes and C-reactive protein showed no difference in the further postoperative course. Intraoperative complications and total operation time (trCCE 114 ± 32 vs. 111 ± 27 min; p = 0.921) did not differ, but wound closure took longer for trCCE (31.5 ± 19 vs. 13 ± 5 min; p = 0.002). CONCLUSIONS: After standardized rectal washout with a colon occlusion device in situ, trCCE was associated without peritoneal contamination and without access-related infectious complications. Based on the findings of this study, a randomized controlled clinical study comparing clinical outcomes of trCCE with lapCCE should be conducted.
Authors: D C Steinemann; P C Müller; P Probst; A-C Schwarz; M W Büchler; B P Müller-Stich; G R Linke Journal: Br J Surg Date: 2017-07 Impact factor: 6.939
Authors: Jonas D Senft; Philip Gath; Tilman Dröscher; Philip C Müller; Benedict Carstensen; Felix Nickel; Beat P Müller-Stich; Georg R Linke Journal: Surg Endosc Date: 2016-04-08 Impact factor: 4.584
Authors: G R Linke; I Tarantino; T Bruderer; J Celeiro; R Warschkow; P E Tarr; B P Müller-Stich; A Zerz Journal: Endoscopy Date: 2012-04-23 Impact factor: 10.093
Authors: Dirk Rolf Bulian; Jürgen Knuth; Nicola Cerasani; Axel Sauerwald; Rolf Lefering; Markus Maria Heiss Journal: Ann Surg Date: 2015-03 Impact factor: 12.969
Authors: Philip C Müller; Daniel C Steinemann; Lukas Chinczewski; Gencay Hatiboglu; Felix Nickel; Kaspar Z'graggen; Beat P Müller-Stich Journal: Surg Endosc Date: 2018-05-01 Impact factor: 4.584
Authors: D Wilhelm; T Vogel; A Jell; S Brunner; M Kranzfelder; N Wantia; H Feussner; D Ostler; S Koller Journal: Surg Endosc Date: 2020-04-06 Impact factor: 4.584
Authors: Carolin Cordewener; Manuel Zürcher; Philip C Müller; Beat P Müller-Stich; Andreas Zerz; Georg R Linke; Daniel C Steinemann Journal: Surg Endosc Date: 2020-09-23 Impact factor: 4.584