title: Pilot comparison of adhesion formation following colonic perforation and repair in a pig model using a transgastric, laparoscopic, or open surgical technique.
abstract: OBJECTIVE
  Postoperative adhesions create significant morbidity and mortality. Natural orifice transluminal endoscopic surgery (NOTES) procedures may reduce or eliminate adhesions by avoiding disruption of the parietal peritoneum. The primary aim of this pilot study was to compare adhesion formation after performance and subsequent repair of colonic perforation via transgastric, laparoscopic, or open surgical techniques. The secondary aim was to test the feasibility and outcome of transgastric management of bowel perforation in a prepared model.
  
  
  METHODS
  15 Yorkshire pigs were divided into three groups of five: transgastric (needle-knife entry with balloon dilation over a wire), laparoscopic, and open surgical. Aspects of adhesion formation (density/vascularity, width of bands, and number of organ pairs involved) were compared after perforation and repair during the same procedure. Intra- and postoperative complications were documented during the 21-day survival period.
  
  
  RESULTS
  All 15 pigs recovered fully with no immediate procedural complications. After 21 days, there was a trend towards a lower adhesion burden regarding density/vascularity and number of organ pairs involved, and a significant reduction in the width of the adhesive bands, when the transgastric group was compared with the surgical groups. Additionally, there was a trend towards decreased adhesions to the peritoneum in the transgastric group.
  
  
  CONCLUSIONS
  Repair of colonic perforation during transgastric (NOTES) procedures appear feasible and safe in a porcine model. There appears to be a trend towards a lower rate of adhesion formation with the transgastric approach compared with laparoscopic or open surgery.
authors.affiliation: Division of Gastroenterology, Medical University of South Carolina, Charleston, South Carolina 29425-2900, USA.
authors.forename: B V
authors.initials: BV
authors.lastname: Pham
authors.forename: K
authors.initials: K
authors.lastname: Morgan
authors.forename: J
authors.initials: J
authors.lastname: Romagnuolo
authors.forename: J
authors.initials: J
authors.lastname: Glenn
authors.forename: S
authors.initials: S
authors.lastname: Bazaz
authors.forename: C
authors.initials: C
authors.lastname: Lawrence
authors.forename: R
authors.initials: R
authors.lastname: Hawes
mesh_terms: D000818:Animals; D003106:Colon / Q000293:injuries* / Q000601:surgery*; D005773:Gastroscopy; D007416:Intestinal Perforation / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures; D010865:Pilot Projects; D018709:Statistics, Nonparametric; D013552:Swine; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*