The inflammatory response in transgastric surgery: gastric content leak leads to localized inflammatory response and higher adhesive disease.
BACKGROUND
Risk of gastric spillage during transgastric surgery is a potential complication of NOTES procedures. The aim of this study was to determine risk outcomes from gastric spillage in a rat survival model by measuring local and systemic inflammatory markers, adhesive disease, and morbidity.


METHODS
We performed a minilaparotomy with needle aspiration of 2 ml of gastric contents mixed with 2 ml of sterile saline (study group, SG) or 4 ml of sterile saline (control group, CG) injected into the peritoneal cavity of 60 male rats. Inflammatory markers (TNFalpha, IL-6, and IL-10) were analyzed at 1, 3, 6, and 24 h postoperatively by obtaining plasma levels and peritoneal washings. At necropsy, the peritoneal cavity was examined grossly for adhesions.


RESULTS
Adhesions were seen more frequently in the SG versus the CG (100% vs. 33.3%, p < 0.014). There was a significant difference in the peritoneal TNFalpha levels in the SG compared with the CG, which peaked 1 h after surgery (p < 0.02). Both peritoneal IL-6 and IL-10 levels were higher in the SG versus the CG, which peaked 3 h after surgery (p < 0.005 and p < 0.001, respectively). All peritoneal inflammatory markers returned to undetectable levels at 24 h for both groups. Plasma cytokines were undetectable at all time intervals.


CONCLUSIONS
The inflammatory response was found to be a localized and not systemic event, with plasma cytokine levels remaining normal while peritoneal washings revealed a brisk, short-lived localized inflammatory response. There was a significantly higher rate of adhesive disease in the SG compared with the CG; this, however did not translate into a difference in apparent clinical outcome. We conclude that gastric leakage in this NOTES rodent model induces a localized inflammatory response, followed by mild to moderate adhesive disease. This may be important in human NOTES.
Ramamoorthy
Sonia L
SL
Center for the Future of Surgery, Department of Surgery, University of California, San Diego Medical Center, San Diego, CA, USA. sramamoorthy@ucsd.edu
Lee
Jeffrey K
JK
Luo
Linda
L
Mintz
Yoav
Y
Cullen
John
J
Easter
David W
DW
Savu
Michelle K
MK
Chock
Alana
A
Carethers
John
J
Horgan
Santiago
S
Talamini
Mark A
MA
D000818:Animals; D016009:Chi-Square Distribution; D004797:Enzyme-Linked Immunosorbent Assay; D005766:Gastrointestinal Contents / Q000737:chemistry*; D018836:Inflammation Mediators / Q000032:analysis*; D016753:Interleukin-10 / Q000032:analysis*; D015850:Interleukin-6 / Q000032:analysis*; D007813:Laparotomy; D023421:Models, Animal; D011183:Postoperative Complications / Q000209:etiology*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology*; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10
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