Devendra Chaudhary1, Arvind Rai2, R. S. Gupta3, Dipendra Pradhan4, Anuradha Chaudhary5,Rohit Namdev6
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is a new form of minimally invasive surgery which eliminates traditional skin incisions by accessing internal body cavities through natural orifices. In our experimental animal study, we compared the incidences intraperitoneal abscess formation, culture swab of peritoneal cavity positive for organism, intraperitoneal adhesion formation and mean adhesion score before and after lavaging the portal of entry of albino rat, i.e. transgastric and transvaginal. On vaginal route as a portal of entry into peritoneal cavity, on the 7th day, 66% rats developed abscesses, 88% rats had culture swab positive and 88% rats developed intraperitoneal adhesion (grade-2) before any cleansing of vaginal cavity with antiseptic solution. Now after lavage with povidone iodine solution, only 11% developed abscesses, 22% were peritoneal swab culture positive and 33% had interbowel and parietal adhesion of (grade 0-1). On 21stday, the complication observed was adhesion formation in pre lavage group of 66% incidence and 16% after vaginal lavage. The incidence of complications were reduced significantly after lavage with antiseptic solution as shown by p values (p<0.01 for abscess formation, p< 0.01 for culture positivity and p< 0.01 for adhesions formation). Also the mean adhesion scoring was significantly reduced (p <0.02) after vaginal lavage on the 7 th day. Gastric route as the portal of entry into the peritoneal cavity, again the same variables were compared on the 7th and the 21st day, but wash was given with antibiotic solution (Cefazolin). On the 7th day, 44% had abscesses, 77% were culture positive and 66% had adhesions (Grade 1-2) before gastric lavage with antibiotic solution. After wash of stomach, 11% were culture positive and 44% developed adhesions (Grade 0-1). Here, abscess formation (p<0.02) and mean adhesion scoring (p<0.05) were significantly reduced after stomach wash. On the 21st day, the incidences of complications were markedly decreased in the post-gastric lavage group. In the group without antibiotic lavage, incidences for adhesions was 50%, culture positivity was 33% and mean adhesion score was 2.66. In the post lavage group, 20% developed adhesions
