title: Pulmonary and peritoneal inflammatory findings in transgastric NOTES compared with laparoscopy: pooled analysis from randomized porcine survival studies.
abstract: BACKGROUND
  Laparoscopy, which is a minimally invasive surgery, is associated with decreased peritoneal adhesions and inflammatory response compared with laparotomy.
  
  
  OBJECTIVE
  To evaluate whether natural orifice transluminal endoscopic surgery (NOTES) leads to an attenuated peritoneal response compared with laparoscopy.
  
  
  METHODS
  Pooled histologic analysis from 2 randomized porcine trials.
  
  
  METHODS
  Laboratory.
  
  
  METHODS
  Histologic analysis of swine undergoing diagnostic laparoscopy, diagnostic NOTES peritoneoscopy, NOTES with transgastric mesh placement, or diagnostic endoscopy (no gastrotomy) followed by laparoscopic mesh placement.
  
  
  METHODS
  The presence and grade of inflammation in necropsy specimens of lung, liver, and spleen as reviewed by a blinded veterinary pathologist.
  
  
  RESULTS
  Four NOTES mesh animals exhibited mesh infections at necropsy. Tissue from 48 swine were available for analysis. Pulmonary inflammation, liver fibrosis, and spleen capsulitis were the primary findings. No difference was seen in the incidence of each finding among groups. The severity of the pulmonary inflammation in the laparoscopy group was significantly higher than in the NOTES groups. The NOTES mesh group exhibited significantly more severe liver fibrosis and spleen capsulitis. There was no difference between clinical behavior, serum white blood cell count, or peritoneal white blood cell count among groups in either study. Intra-abdominal pressures during NOTES were lower than during laparoscopy.
  
  
  CONCLUSIONS
  Pooled analysis of 2 separate studies.
  
  
  CONCLUSIONS
  More severe pulmonary inflammation was found in animals undergoing longer laparoscopic procedures with higher intra-abdominal pressures. Intraperitoneal inflammation was most significant with transgastric mesh placement, likely caused by infections.
authors: Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors: Erica
authors: E
authors: Moran
authors: Martha
authors: M
authors: Hanes
authors: Marianne
authors: M
authors: Huebner
authors: Christopher J
authors: CJ
authors: Gostout
authors: Juliane
authors: J
authors: Bingener
mesh_terms: D000818:Animals; D005260:Female; D007249:Inflammation / Q000276:immunology / Q000473:pathology*; D010535:Laparoscopy / Q000009:adverse effects*; D008103:Liver Cirrhosis / Q000276:immunology / Q000473:pathology*; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects*; D011014:Pneumonia / Q000276:immunology / Q000473:pathology*; D019919:Prosthesis Implantation / Q000009:adverse effects; D011897:Random Allocation; D013158:Splenic Diseases / Q000276:immunology / Q000473:pathology*; D013526:Surgical Mesh / Q000009:adverse effects; D013552:Swine