title: Natural orifice transluminal endoscopic surgery (NOTES): assessment of peritoneal bacterial load after intraperitoneal antimicrobial wash and evaluation of hemodynamic changes in a porcine model.
abstract: OBJECTIVE
  Natural orifice transluminal endoscopic surgery (NOTES) is a promising newly developed procedure; however, it is associated with many complications. The main aim of our study is to assess whether peritoneal wash with antibiotics decreases the bacterial load contamination related to the transgastric approach.
  
  
  METHODS
  Ten female farm pigs underwent transgastric peritoneoscopy with fallopian tubal ligation. Five pigs were randomized to antibiotic wash of the peritoneal cavity and five to placebo. All animals were given one intravenous dose of antibiotic before the procedure. Hemodynamic variables were continuously monitored throughout the procedure. The next day, peritoneal cultures were taken. The fallopian tubes were inspected to determine the success of ligation and the gastric incision sites were assessed for leakage.
  
  
  RESULTS
  No significant difference was noted between the antibiotic peritoneal wash group and the placebo group in terms of peritoneal bacterial load with respective median colony-forming units per ml (CFU/ml) of 0 [0; 1] vs. 0 [0; 4], p = 0.637. No clinically significant hemodynamic changes were noted during the procedure.
  
  
  CONCLUSIONS
  The results of our study indicate that NOTES carries minimal risk of peritoneal bacterial contamination, regardless of the use of intraperitoneal antibiotics, and is not associated with hemodynamic compromise.
authors.affiliation: Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Assaad
authors.initials: A
authors.lastname: Soweid
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
authors.forename: Abdallah
authors.initials: A
authors.lastname: Kobeissy
authors.forename: Nadim
authors.initials: N
authors.lastname: El Majzoub
authors.forename: Mohammad
authors.initials: M
authors.lastname: Khreiss
authors.forename: Mohammad
authors.initials: M
authors.lastname: Alaeddine
authors.forename: Chakib
authors.initials: C
authors.lastname: Ayoub
authors.forename: Muhieddine
authors.initials: M
authors.lastname: Seoud
authors.forename: Ghassan
authors.initials: G
authors.lastname: Matar
authors.forename: Faek
authors.initials: F
authors.lastname: Jamali
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000494:pharmacology; D058491:Bacterial Load / Q000187:drug effects*; D004195:Disease Models, Animal; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D010101:Oxygen Consumption; D010537:Peritoneum / Q000187:drug effects / Q000382:microbiology* / Q000601:surgery; D018709:Statistics, Nonparametric; D013552:Swine
chemical_list: D000890:Anti-Infective Agents