Introduction: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical technique through which operations are performed by entering the abdominal cavity through a natural orifice such as the stomach. Infection is a potential risk of the procedure and the potential pathogens are different than with skin incisions. Currently, there is little data regarding prophylactic antibiotic treatment for NOTES.
Methods: 30 Sprague-Dawley rats underwent mini-laparotomy under general anesthesia in accordance with the UCSD Institutional Animal Care and Use Committee regulations. The control group (n=10) underwent a sham procedure where a single stitch was placed in the anterior stomach. The saline treated group (n=10) underwent mini-laparotomy followed by needle gastrotomy and gastric irrigation with normal saline. Following irrigation, the fluid was expressed from the stomach into the abdominal cavity. The gastrotomy and then the abdomen were closed. The antibiotic treated group (n=10) underwent gastric irrigation with diluted antibiotic containing enrofloxacin solution followed by spillage and closure. All rats survived the operation. One rat from the Saline group was euthanized on post-operative day 2 for wound complications due to a technical error. All other rats survived and were euthanized at 4 weeks.
Results: Weight gain was similar amongst groups. In the saline treated only group, 3 out of 9 rats (33%) developed intra-abdominal abscess found at necropsy. In the control and antibiotic treated groups, no abscess was found at necropsy. Adhesions to the abdominal wall formation were found in four rats out of ten in the saline group. No adhesions were noted in the control or antibiotic treated groups.
Conclusions: In a pilot study of a murine model designed to simulate NOTES gastric spillage, pre-op gastric antibiotic lavage decreased the adhesion and infection rate when compared to saline only lavage.