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Laparoscopic vs Natural Orifice Transluminal Endoscopic Surgery (NOTES) for Duodenal Perforation Repair: A Randomized Controlled Trial in a Porcine Model

2012; Lippincott Williams & Wilkins; Volume: 107; Linguagem: Inglês

10.14309/00000434-201210001-01897

1572-0241

Faek R. Jamali, Mohammed Saad, Nageshwar Reddy, Joseph Nassif, Mohammed Alaeddine, Nadim El-Majzoub, Sara Hamadeh, Rami Diab, Assaad Soweid,

Gastrointestinal disorders and treatments

Purpose: Perforation is the one of the most serious complications of peptic ulcer disease. The aim of this study was to assess the feasibility, efficacy, and safety of using NOTES for the repair of duodenal perforation in comparison with laparoscopic repair. Methods: Twenty one pigs underwent a laparoscopic perforation of the duodenum and left for a period of 15 hours to simulate a duodenal ulcer perforation with peritonitis. Pigs were afterwards randomized into either NOTES or laparoscopic repair. The animals were afterwards observed for 7 days and then underwent euthanasia and necropsy. Main outcomes measured were, operative outcomes that include mortality, morbidity, and operative time, as well as necropsy outcomes such as weight change and peritoneal adhesions. Results: Laparoscopic perforation was successfully performed in all animals. In the NOTES arm (n=11), 1 pig was shifted into the laparoscopic group (technical) while the other 10 pigs survived without complications. In the laparoscopic group, all 11 animals thrived without complications. Mortality was zero in both groups. Morbidity rate was similar as well. The operative time, weight change, and adhesion formation rate did not show any statistically significant difference between the two groups.Figure: [1897] Necropsy of a pig that underwent laparoscopic repair showing the patched perforation.Conclusion: NOTES repair of duodenal perforation is technically feasible, efficacious, and safe approach compared to laparoscopic management. Applying this technique to the clinical scenario of duodenal ulcer perforation seems promising.