Acute-phase response in pigs undergoing laparoscopic, transgastric or trans- colonic notes peritoneoscopy with us or eus exploration

Background : Laparoscopic surgery is associated with reduced surgical trauma, therefore with acute-phase response of lower magnitude as compared with open surgery. We hypothesized that NOTES might induce reduced immune response as compared with laparoscopy. Objective : To compare acute-phase reactants in a controlled trial of laparoscopic peritoneoscopy and ultrasonography versus transgastric or transcolonic NOTES peritoneoscopy and intraperi- toneal endoscopic US. Methods : Eighteen pigs were divided in 3 groups : laparoscopy, transgastric and transcolonic NOTES. Serum levels of IL-6 and TNF-a were determined preoperatively and at day 2. Serum levels of haptoglobin and IL-6 mRNA levels from isolated white blood cells were measured by RT-PCR at days 0, 1, 2 and 7. Necropsy was performed at sacrifice, with peritoneal fluid microbiological analy- sis, macroscopic and microscopic examinations on gastrotomy/ colotomy or abdominal wall closure sites, liver and parietal peri- toneum biopsy sites and any area suggestive of infection. Results : The groups were similar with regards to perito- neoscopy completeness, ultrasonographic examination and biop- sies. The duration of NOTES procedures was significantly longer than laparoscopic procedures. Minor complications were observed in most animals by macroscopic and microscopic examination, but NOTES procedures were associated with severe complications in 3 pigs (fistula, abscess, mortality). No significant differences in acute-phase reactants levels were found between groups. Conclusions : No significant difference in the acute-phase reac- tants could be demonstrated between surgical and NOTES proce- dures. NOTES was however associated with more severe septic complications. Optimal closure remains a challenge and better devices are needed to avoid them. (Acta gastroenterol. belg., 2012, 75, 28-34).