Feasibility and safety of adhesiolysis using transgastric NOTES approach: a pilot survival study in a porcine model.
OBJECTIVE
Although adhesions can be removed by adhesiolysis using laparotomy or laparoscopy, they typically recur sometimes with equal severity. It is suggested that minimizing the invasiveness of the operative technique by using natural orifice translumenal endoscopic surgery (NOTES) may reduce adhesion re-formation. The aim of the study was to evaluate the feasibility and safety of adhesiolysis by using a novel transgastric NOTES approach and collect pilot data on adhesion recurrence after transgastric NOTES adhesiolysis.


METHODS
One nonsurvival and 5 survival female pigs were used in this experimental survival study. Interventions included (a) induction of adhesions by laparotomy, (b) 2 weeks survival, (c) transgastric NOTES adhesiolysis with endoscopic evaluation and scoring of adhesions before and immediately after adhesiolysis, (d) 2 weeks survival, and (e) necropsy with endoscopic and necroscopic evaluation and scoring of recurrent adhesions. Main outcome measures were (a) survival and complication rates and (b) assessment of adhesion formation and re-formation using the Hopkins Adhesion Formation Score.


RESULTS
No mortality and no complications were observed. A total of 11 adhesions formed before the adhesiolysis in 5 survival study animals. All were successfully divided. The frequency of adhesions and median adhesion formation score decreased significantly immediately after adhesiolysis compared with that prior to the procedure (frequency, 11 vs 0, P = .011; the median score = 2.0 [range 1-3] vs 0.0 [range 0-0], P = .004). The treatment gains maintained at 2 weeks after the adhesiolysis.


CONCLUSIONS
The limitations of this study were the low number of study animals and short-term follow-up data.


CONCLUSIONS
Adhesiolysis using NOTES transgastric approach is feasible, safe, and effective with minimal adhesion re-formation.
St Michael's Hospital, Toronto, Ontario, Canada. dubcencoe@smh.toronto.on.ca
Elena
E
Dubcenco
Teodor
T
Grantcharov
Catherine J
CJ
Streutker
Depeng
D
Jiang
Nancy N
NN
Baxter
Jeffrey P
JP
Baker
D000818:Animals; D004195:Disease Models, Animal; D005240:Feasibility Studies; D005260:Female; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods* / Q000401:mortality*; D010529:Peritoneal Cavity / Q000473:pathology / Q000601:surgery*; D010865:Pilot Projects; D011897:Random Allocation; D018570:Risk Assessment; D017751:Safety Management; D015996:Survival Rate; D013552:Swine; D000267:Tissue Adhesions / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome