Clinical Trials Study
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World J Gastroenterol. Nov 14, 2014; 20(42): 15763-15770
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15763
Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery
Hirohito Mori, Hideki Kobara, Takaaki Tsushimi, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki
Hirohito Mori, Hideki Kobara, Shintaro Fujihara, Noriko Nishiyama, Tae Matsunaga, Maki Ayaki, Tatsuo Yachida, Joji Tani, Hisaaki Miyoshi, Asahiro Morishita, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan
Hirohito Mori, Takaaki Tsushimi, Department of Gastroenterological Surgery, Ehime Rosai Hospital, 13-27, Minamikomatsubara, Niihama, Ehime 792-8550, Japan
Author contributions: Mori H was responsible for conceiving the research and drafting the article; Kobara H, Tsushimi T, Fujihara S, Nishiyama N, Matsunaga T, Tani J, Miyoshi H, Ayaki M, Morishita A and Yachida T participated equally in the work; Masaki T provided a critical revision of the manuscript for intellectual content and was responsible for the final approval of the manuscript.
Correspondence to: Hirohito Mori, MD, PhD, Department of Gastroenterology and Neurology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. hiro4884@med.kagawa-u.ac.jp
Telephone: +81-87-8912156 Fax: +81-87-8912158
Received: March 25, 2014
Revised: April 24, 2014
Accepted: June 12, 2014
Published online: November 14, 2014
Abstract

AIM: To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery.

METHODS: Twenty two patients who were diagnosed with a gastric gastrointestinal stromal tumor were enrolled. In former term, irrigations of the stomach were conducted whenever it was necessary, not systematically (Non systemic lavage group). In latter term, the stomach was thoroughly cleaned with 2000 mL of saline using an endoscope with a water jet, and Duodenal balloon occlusion was conducted to prevent refluxed bile and pancreatic juice (Systemic lavage+balloon occlusion group). The gastric wall was sprayed with 20 mL of distilled water, and 20 mL of gastric juice was collected in a sterile tube and submitted for culture. 20 mL of ascites was also collected from the laparoscopic ports and submitted for culture. We compared WBC, CRP, BT between two groups, and verify the reduction effect of bacterial counts in Systemic lavage+balloon occlusion group.

RESULTS: WBC count before, 1 d after, and 3 d after laparoscopic and endoscopic cooperative surgery (LECS) were 5060 (95%CI: 4250-9640), 12140 (6050-14110), and 6910 (5320-12520) in Non systemic lavage group, 4400 (3660-7620), 8910 (6480-10980), and 5950 (4840-7860) in Systemic lavage+balloon occlusion group. Significant differences between two groups at the day after LECS (P = 0.029) and the 3 d after LECS (P = 0.042). CRP levels in Non systemic lavage group and in Systemic lavage+balloon occlusion group were significantly different at the day after LECS (P = 0.005) and the 3 d after LECS (P = 0.028). BTs (°C) in Non systemic lavage group and in Systemic lavage+balloon occlusion group were also significantly different at the day after LECS (P = 0.004) and the 3 d after LECS (P = 0.006). In a logarithmic comparison, bacterial load before gastric lavage, after lavage, and ascites culture were 6.08 (95%CI: 4.04-6.97), 0.48 (0-0.85), and 0.21 (0-0.56). The bacterial counts before and after gastric lavage were significantly suppressed (P = 0.007), but no significant difference between gastric juice culture after lavage and ascites (P = 0.154).

CONCLUSION: Pre-LECS lavage with 2000 mL of saline exhibited a bacteria-reducing effect equivalent to disinfectants and obtained favorable results in terms of clinical symptoms and data.

Keywords: Laparoscopic and endoscopic cooperative surgery, Systemic gastric lavage, Disinfection, Bacterial counts, Duodenal balloon occlusion

Core tip: Although laparoscopic and endoscopic cooperative surgery (LECS) is a safer minimally invasive surgery that utilizes the advantages of both flexible endoscopy and laparoscopy, LECS invariably involves exposure to bacteria in the oral cavity because the flexible endoscope is passed through the oral cavity into the stomach. Nevertheless, there was no report how to disinfect the digestive tract more effectively. In this study, we established the systematic disinfection procedures of digestive tract lavage, endoscope disinfection and clean procedure of endoscopist and assistants in preparation for more minimal invasive flexible endoscopic surgery in near future.