Acute inflammatory response to transgastric natural orifice transluminal endoscopic surgery peritoneoscopy: An experimental study in swine
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2013-01-01
Autores
Rezende, Marcelo [UNIFESP]
Montero, Edna Frasson de Souza [UNIFESP]
Salomão, Reinaldo [UNIFESP]
Brunialti, Milena [UNIFESP]
Rodrigues, Rodrigo [UNIFESP]
Gomes, Gustavo [UNIFESP]
Della Libera, Alice
Ferrari, Angelo Paulo [UNIFESP]
Della Libera, Ermelindo [UNIFESP]
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OBJECTIVE: To investigate the impact of transgastric peritoneal access on plasma biomarkers of acute inflammatory response in comparison to laparoscopy.METHODS: This was a prospective and comparative study in a porcine model. Transgastric peritoneal access performed by natural orifice transluminal endoscopic surgery was compared with laparoscopy. Laparotomy and sham groups were used as positive and negative controls, respectively. Thirty-four pigs were assigned to receive transgastric natural orifice transluminal endoscopic surgery (n = 12), laparoscopy (n = 8), laparotomy (n = 8) or a sham procedure involving only anesthesia (n = 6). in the natural orifice transluminal endoscopic surgery group, peritoneoscopy was performed with a gastroscope via transgastric access. Blood samples were collected at baseline and 1, 3, 6, 9 and 24 h after the surgical procedure for measurement of interleukins 1 beta, 6 and 10 and tumor necrosis factor-alpha. A complete blood count was performed, and C-reactive protein levels were measured at baseline and at 24 h.RESULTS: All surgical and endoscopic procedures were performed without major complications. Peritoneal cavity inventory showed no signs of peritonitis in any animal. Interleukin 1 beta, interleukin 10 and tumor necrosis factor-alpha levels were below the threshold of detection. the mean level of interleukin 6 was statistically significantly higher in the laparotomy group than in the other groups (p < 0.05), with no significant differences among the sham, laparoscopy and natural orifice transluminal endoscopic surgery groups (p > 0.05). C-reactive protein analysis indicated significant increases in all groups, with no differences among the groups. Complete blood count analysis showed no differences among the groups.CONCLUSIONS: Based on the observed interleukin 6 patterns, the systemic inflammatory response resulting from transgastric peritoneal access by natural orifice transluminal endoscopic surgery is similar in intensity to the response that occurs after laparoscopy.
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Clinics. São Paulo: Hospital Clinicas, Univ São Paulo, v. 68, n. 11, p. 1433-1439, 2013.