Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery.
OBJECTIVE
To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery.


METHODS
Twenty two patients who were diagnosed with a gastric gastrointestinal stromal tumor were enrolled. In former term, irrigations of the stomach were conducted whenever it was necessary, not systematically (Non systemic lavage group). In latter term, the stomach was thoroughly cleaned with 2000 mL of saline using an endoscope with a water jet, and Duodenal balloon occlusion was conducted to prevent refluxed bile and pancreatic juice (Systemic lavage+balloon occlusion group). The gastric wall was sprayed with 20 mL of distilled water, and 20 mL of gastric juice was collected in a sterile tube and submitted for culture. 20 mL of ascites was also collected from the laparoscopic ports and submitted for culture. We compared WBC, CRP, BT between two groups, and verify the reduction effect of bacterial counts in Systemic lavage+balloon occlusion group.


RESULTS
WBC count before, 1 d after, and 3 d after laparoscopic and endoscopic cooperative surgery (LECS) were 5060 (95%CI: 4250-9640), 12140 (6050-14110), and 6910 (5320-12520) in Non systemic lavage group, 4400 (3660-7620), 8910 (6480-10980), and 5950 (4840-7860) in Systemic lavage+balloon occlusion group. Significant differences between two groups at the day after LECS (P = 0.029) and the 3 d after LECS (P = 0.042). CRP levels in Non systemic lavage group and in Systemic lavage+balloon occlusion group were significantly different at the day after LECS (P = 0.005) and the 3 d after LECS (P = 0.028). BTs (°C) in Non systemic lavage group and in Systemic lavage+balloon occlusion group were also significantly different at the day after LECS (P = 0.004) and the 3 d after LECS (P = 0.006). In a logarithmic comparison, bacterial load before gastric lavage, after lavage, and ascites culture were 6.08 (95%CI: 4.04-6.97), 0.48 (0-0.85), and 0.21 (0-0.56). The bacterial counts before and after gastric lavage were significantly suppressed (P = 0.007), but no significant difference between gastric juice culture after lavage and ascites (P = 0.154).


CONCLUSIONS
Pre-LECS lavage with 2000 mL of saline exhibited a bacteria-reducing effect equivalent to disinfectants and obtained favorable results in terms of clinical symptoms and data.
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Hirohito
H
Mori
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Hideki
H
Kobara
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Takaaki
T
Tsushimi
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Shintaro
S
Fujihara
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Noriko
N
Nishiyama
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Tae
T
Matsunaga
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Maki
M
Ayaki
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Tatsuo
T
Yachida
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Joji
J
Tani
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Hisaaki
H
Miyoshi
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Asahiro
A
Morishita
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan.
Tsutomu
T
Masaki
D000368:Aged; D058491:Bacterial Load; D005260:Female; D005750:Gastric Juice / Q000382:microbiology; D046152:Gastrointestinal Stromal Tumors / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D013270:Stomach / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D013274:Stomach Neoplasms / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
D012965:Sodium Chloride
Bacterial counts; Disinfection; Duodenal balloon occlusion; Laparoscopic and endoscopic cooperative surgery; Systemic gastric lavage