Journal article
Safe alternative transgastric peritoneal access in humans: NOTES
Surgery, Vol.149(1), pp.147-152
2011
DOI: 10.1016/j.surg.2009.10.060
PMID: 20122706
Abstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Details
- Title: Subtitle
- Safe alternative transgastric peritoneal access in humans: NOTES
- Creators
- Peter NAU - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United StatesJoel ANDERSON - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United StatesLynn HAPPEL - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United StatesBenjamin YUH - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United StatesVimal K NARULA - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United StatesBradley NEEDLEMAN - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United StatesE. Christopher ELLISON - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United StatesW. Scott MELVIN - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United StatesJeffrey W HAZEY - Ohio State University Medical Center, Department of Surgery, Columbus, OH, United States
- Resource Type
- Journal article
- Publication Details
- Surgery, Vol.149(1), pp.147-152
- Publisher
- Elsevier; New York, NY
- DOI
- 10.1016/j.surg.2009.10.060
- PMID
- 20122706
- ISSN
- 0039-6060
- eISSN
- 1532-7361
- Language
- English
- Date published
- 2011
- Academic Unit
- Surgery
- Record Identifier
- 9984051981302771
Metrics
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