Prevention of infection by betadine irrigation of stomach during natural orifice transluminal endoscopic surgery

Abstract

Objective To study the safety and effect of betadine irrigation of stomach for preventing infection during natural orifice transluminal endoscopic surgery （NOTES）. Methods The clinical data of 9 patients receiving transgastric NOTES at our center from March 2009 to June 2010 were reviewed. After general anesthesia, the stomachs were lavaged with 200 to 300 ml betadine. Then the endoscope was maneu- vered in the peritoneal cavity after the creation of the gastronomy, and some procedures were performed with assistance of laparoscope. A total of 5 ml stomach fluid was collected before and after lavage, and 5 ml of peritoneal fluid was collected at the end of the procedure. At last the gastronomy was closed with clips. Fol- low-up endoscopy was performed 1 week and 6 months after NOTES, respectively. Results All the surgical procedures were performed successfuliy, 5 of which under aid of laparoscope. The gastric fluid collected be- fore lavage was negative for bacteria in 2 patients, and enteric bacilli was the main bacteria in the stomach fluid of other 7 patients, with an average bacterial load of 35.6 ×10^3 CFU/ml. No bacteria was cultured in gastric fluid after lavage and peritoneal fluid after NOTES. No inflammation, ulcer or bleeding was observed under endoscopy 1 week after NOTES. No surgical complications including infection occurred in 6 months after NOTES. Conclusion Betadine irrigation of stomach is safe and effective for preventing infection during NOTES. Further studies are needed for assessing the effectiveness and safety of betadine irrigation in NOTES. Key words: Infection; Natural orifice transluminal endoscopic surgery; Povidone-Iodine; Transgastric approach; Clinical protocols