Transgastric instrumentation and bacterial contamination of the peritoneal cavity

Vimal K. Narula, Jeffrey W. Hazey, David B. Renton, Kevin M. Reavis, Christopher M. Paul, Kristen E. Hinshaw, Bradley J. Needleman, Dean J. Mikami, E. Christopher Ellison, W. Scott Melvin

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is a rapidly evolving technique providing access to the peritoneum utilizing an endoscope via a natural orifice. One of the most significant requirements of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in patients requiring a gastrotomy Roux-en-Y gastric bypass (LSRYGB). Methods: We prospectively studied 50 patients undergoing a gastrotomy with creation of a gastrojejunostomy during LSRYGB. We recorded the patient's proton-pump inhibitor (PPI) utilization preoperatively and sampled gastric contents without lavage. We also sampled peritoneal fluid prior to and after gastrotomy, noting the length of time the gastrotomy was open to the peritoneum. Each of the three samples was sent for bacterial colony counts, and culture with identification of species. Results: Fifty patients underwent LSRYGB with a mean operative time of 93 min. The gastrotomy was open to the peritoneal cavity for an average of 18 min. Seventeen of 50 patients were on PPIs preoperatively, resulting in a significant difference in postgastrostomy peritoneal bacterial counts. The average number of colony-forming units (CFU) of the gastric aspirate was 22,303 CFU/ml. Peritoneal aspirates obtained for examination prior to creation of a gastrotomy showed no CFUs in 44 of 50 patients. Peritoneal sampling after gastrotomy showed contamination of the abdomen with an average of 1102 CFU/ml. There was no correlation between the bacterial load in the stomach and peritoneal load after gastrotomy. No infectious complications or leaks developed. One complication of rhabdomyolysis in a patient with no peritoneal bacterial contamination developed. Conclusions: Transgastric instrumentation does contaminate the abdominal cavity but pathogens are clinically insignificant due to species or bacterial load. Patients on PPIs do have an increased bacterial load in the gastric aspirate, with no clinical significant infection.

Original languageEnglish (US)
Pages (from-to)605-611
Number of pages7
JournalSurgical Endoscopy and Other Interventional Techniques
Volume22
Issue number3
DOIs
StatePublished - Mar 2008
Externally publishedYes

Fingerprint

Peritoneal Cavity
Bacterial Load
Stomach
Gastric Bypass
Stem Cells
Peritoneum
Natural Orifice Endoscopic Surgery
Gastrointestinal Contents
Rhabdomyolysis
Abdominal Cavity
Proton Pump Inhibitors
Endoscopes
Ascitic Fluid
Therapeutic Irrigation
Operative Time
Abdomen
Infection

Keywords

  • Endolumenal surgery
  • Natural orifice translumenal endoscopic surgery
  • Transgastric surgery

ASJC Scopus subject areas

  • Surgery

Cite this

Transgastric instrumentation and bacterial contamination of the peritoneal cavity. / Narula, Vimal K.; Hazey, Jeffrey W.; Renton, David B.; Reavis, Kevin M.; Paul, Christopher M.; Hinshaw, Kristen E.; Needleman, Bradley J.; Mikami, Dean J.; Ellison, E. Christopher; Melvin, W. Scott.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 22, No. 3, 03.2008, p. 605-611.

Research output: Contribution to journalArticle

Narula, VK, Hazey, JW, Renton, DB, Reavis, KM, Paul, CM, Hinshaw, KE, Needleman, BJ, Mikami, DJ, Ellison, EC & Melvin, WS 2008, 'Transgastric instrumentation and bacterial contamination of the peritoneal cavity', Surgical Endoscopy and Other Interventional Techniques, vol. 22, no. 3, pp. 605-611. https://doi.org/10.1007/s00464-007-9661-6
Narula, Vimal K. ; Hazey, Jeffrey W. ; Renton, David B. ; Reavis, Kevin M. ; Paul, Christopher M. ; Hinshaw, Kristen E. ; Needleman, Bradley J. ; Mikami, Dean J. ; Ellison, E. Christopher ; Melvin, W. Scott. / Transgastric instrumentation and bacterial contamination of the peritoneal cavity. In: Surgical Endoscopy and Other Interventional Techniques. 2008 ; Vol. 22, No. 3. pp. 605-611.
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T1 - Transgastric instrumentation and bacterial contamination of the peritoneal cavity

AU - Narula, Vimal K.

AU - Hazey, Jeffrey W.

AU - Renton, David B.

AU - Reavis, Kevin M.

AU - Paul, Christopher M.

AU - Hinshaw, Kristen E.

AU - Needleman, Bradley J.

AU - Mikami, Dean J.

AU - Ellison, E. Christopher

AU - Melvin, W. Scott

PY - 2008/3

Y1 - 2008/3

N2 - Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is a rapidly evolving technique providing access to the peritoneum utilizing an endoscope via a natural orifice. One of the most significant requirements of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in patients requiring a gastrotomy Roux-en-Y gastric bypass (LSRYGB). Methods: We prospectively studied 50 patients undergoing a gastrotomy with creation of a gastrojejunostomy during LSRYGB. We recorded the patient's proton-pump inhibitor (PPI) utilization preoperatively and sampled gastric contents without lavage. We also sampled peritoneal fluid prior to and after gastrotomy, noting the length of time the gastrotomy was open to the peritoneum. Each of the three samples was sent for bacterial colony counts, and culture with identification of species. Results: Fifty patients underwent LSRYGB with a mean operative time of 93 min. The gastrotomy was open to the peritoneal cavity for an average of 18 min. Seventeen of 50 patients were on PPIs preoperatively, resulting in a significant difference in postgastrostomy peritoneal bacterial counts. The average number of colony-forming units (CFU) of the gastric aspirate was 22,303 CFU/ml. Peritoneal aspirates obtained for examination prior to creation of a gastrotomy showed no CFUs in 44 of 50 patients. Peritoneal sampling after gastrotomy showed contamination of the abdomen with an average of 1102 CFU/ml. There was no correlation between the bacterial load in the stomach and peritoneal load after gastrotomy. No infectious complications or leaks developed. One complication of rhabdomyolysis in a patient with no peritoneal bacterial contamination developed. Conclusions: Transgastric instrumentation does contaminate the abdominal cavity but pathogens are clinically insignificant due to species or bacterial load. Patients on PPIs do have an increased bacterial load in the gastric aspirate, with no clinical significant infection.

AB - Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is a rapidly evolving technique providing access to the peritoneum utilizing an endoscope via a natural orifice. One of the most significant requirements of this technique is the need to minimize the risk of clinically significant peritoneal contamination. We report the bacterial load and contamination of the peritoneal cavity in patients requiring a gastrotomy Roux-en-Y gastric bypass (LSRYGB). Methods: We prospectively studied 50 patients undergoing a gastrotomy with creation of a gastrojejunostomy during LSRYGB. We recorded the patient's proton-pump inhibitor (PPI) utilization preoperatively and sampled gastric contents without lavage. We also sampled peritoneal fluid prior to and after gastrotomy, noting the length of time the gastrotomy was open to the peritoneum. Each of the three samples was sent for bacterial colony counts, and culture with identification of species. Results: Fifty patients underwent LSRYGB with a mean operative time of 93 min. The gastrotomy was open to the peritoneal cavity for an average of 18 min. Seventeen of 50 patients were on PPIs preoperatively, resulting in a significant difference in postgastrostomy peritoneal bacterial counts. The average number of colony-forming units (CFU) of the gastric aspirate was 22,303 CFU/ml. Peritoneal aspirates obtained for examination prior to creation of a gastrotomy showed no CFUs in 44 of 50 patients. Peritoneal sampling after gastrotomy showed contamination of the abdomen with an average of 1102 CFU/ml. There was no correlation between the bacterial load in the stomach and peritoneal load after gastrotomy. No infectious complications or leaks developed. One complication of rhabdomyolysis in a patient with no peritoneal bacterial contamination developed. Conclusions: Transgastric instrumentation does contaminate the abdominal cavity but pathogens are clinically insignificant due to species or bacterial load. Patients on PPIs do have an increased bacterial load in the gastric aspirate, with no clinical significant infection.

KW - Endolumenal surgery

KW - Natural orifice translumenal endoscopic surgery

KW - Transgastric surgery

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