title: Acute-phase response in pigs undergoing laparoscopic, transgastric or transcolonic notes peritoneoscopy with us or eus exploration.
abstract: BACKGROUND
  Laparoscopic surgery is associated with reduced surgical trauma, therefore with acute-phase response of lower magnitude as compared with open surgery. We hypothesized that NOTES might induce reduced immune response as compared with laparoscopy.
  
  
  OBJECTIVE
  To compare acute-phase reactants in a controlled trial of laparoscopic peritoneoscopy and ultrasonography versus transgastric or transcolonic NOTES peritoneoscopy and intraperitoneal endoscopic US.
  
  
  METHODS
  Eighteen pigs were divided in 3 groups: laparoscopy, transgastric and transcolonic NOTES. Serum levels of IL-6 and TNF-α were determined preoperatively and at day 2. Serum levels of haptoglobin and IL-6 mRNA levels from isolated white blood cells were measured by RT-PCR at days 0, 1, 2 and 7. Necropsy was performed at sacrifice, with peritoneal fluid microbiological analysis, macroscopic and microscopic examinations on gastrotomy/colotomy or abdominal wall closure sites, liver and parietal peritoneum biopsy sites and any area suggestive of infection.
  
  
  RESULTS
  The groups were similar with regards to peritoneoscopy completeness, ultrasonographic examination and biopsies. The duration of NOTES procedures was significantly longer than laparoscopic procedures. Minor complications were observed in most animals by macroscopic and microscopic examination, but NOTES procedures were associated with severe complications in 3 pigs (fistula, abscess, mortality). No significant differences in acute-phase reactants levels were found between groups.
  
  
  CONCLUSIONS
  No significant difference in the acute-phase reactants could be demonstrated between surgical and NOTES procedures. NOTES was however associated with more severe septic complications. Optimal closure remains a challenge and better devices are needed to avoid them.
authors.affiliation: Division of Hepato-Biliary and Pancreatic Surgery, Department of Abdominal Surgery and Transplantation, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Brussels, Belgium. julie.navez@student.uclouvain.be
authors.forename: Julie
authors.initials: J
authors.lastname: Navez
authors.forename: Ralph
authors.initials: R
authors.lastname: Yeung
authors.forename: Christophe
authors.initials: C
authors.lastname: Remue
authors.forename: Charles
authors.initials: C
authors.lastname: Descamps
authors.forename: Benoît
authors.initials: B
authors.lastname: Navez
authors.forename: Jean-Franåois
authors.initials: JF
authors.lastname: Gigot
authors.forename: Peter
authors.initials: P
authors.lastname: Starkel
authors.forename: Marianne
authors.initials: M
authors.lastname: Philippe
authors.forename: Anne
authors.initials: A
authors.lastname: Jouret-Mourin
authors.forename: Marie Lys
authors.initials: ML
authors.lastname: Van de Weerdt
authors.forename: Francis
authors.initials: F
authors.lastname: Zech
authors.forename: Pierre
authors.initials: P
authors.lastname: Gianello
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Deprez
mesh_terms: D000210:Acute-Phase Reaction; D000818:Animals; D019160:Endosonography; D005260:Female; D006242:Haptoglobins / Q000032:analysis; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000379:methods*; D057605:Natural Orifice Endoscopic Surgery; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D006242:Haptoglobins; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha