Journal of the American College of Surgeons RSS feed: Articles in Press. The Journal of the American College of Surgeons ( JACS ) is a monthly journal publishing peer-reviewed original contributions on all aspects of surgery. These contributions include, but are not limited to, original clinical studies, review articles, and experimental investigations with clear clinical relevance. In general, case reports are not considered for publication. As the official scientific journal of the American College of Surgeons, JACS has the goal of providing its readership the highest quality rapid retrieval of information relevant to surgeons. Visit the Journal of the American College of Surgeons Web site maintained by the American College of Surgeons at http://www.journalacs.org Subscription orders and inquiries should be mailed to: Elsevier Subscription Customer Service 6277 Sea Harbor Dr. Orlando, FL 32887-4800 USA Telephone: Toll free (for customers inside U.S./Canada): 800-654-2452 For customers outside the U.S./Canada: 407-345-4000 Fax: 407-363-9661 E-mail: elspcs@elsevier.com http://www.journalacs.org//inpress?rss=yesElsevier Inc.en © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved. Journal of the American College of Surgeons1072-75152010-02-01 © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.journalacs.org/article/PIIS1072751509016147/abstract?rss=yesBackground: Procedure-related complications contribute to 1-year mortality in patients with perforated ulcers. Natural orifice translumenal endoscopic surgery (NOTES) might offer a new repair approach.Study design: Swine were randomized to laparoscopic or NOTES repair. Laparoscopic gastrotomy creation (1 cm) was followed by 4 hours soilage time. After peritoneal cavity irrigation (per group assignment), repair proceeded with a laparoscopic or NOTES approach. For NOTES repair, omentum was endoscopically grasped, pulled into the gastric lumen, and fixed with metallic clips. Feasibility; time to complete procedures; pneumoperitoneal pressures; and clinical parameters, including necropsy and peritoneal culture at 2 weeks, were recorded.Results: NOTES repair failed in 1 animal (technical); repair was completed laparoscopically, and data were analyzed as intention to treat. Specific NOTES repair time (minutes) was comparable with laparoscopy (36 versus 46; p = 0.2). Mean abdominal pressure (mmHg) required to complete NOTES repair was lower than in laparoscopy (4 versus 12; p < 0.001). Nineteen of 23 animals thrived until necropsy at 2 weeks. Three animals succumbed to airway compromise in recovery; 1 NOTES animal failed to thrive on postoperative day 7. No intra-abdominal cause for these deaths was found. At necropsy all repairs were intact, and peritoneal cultures revealed a small and equivalent amount of colony-forming units in each group.Conclusions: Endoscopic ulcer repair appears technically feasible with similar clinical and infectious outcomes to laparoscopy. The lower required pneumoperitoneal pressures used in these NOTES techniques are recognizable different outcomes from laparoscopy and can be advantageous in critically ill patients.Natural Orifice Translumenal Endoscopic Surgery Used for Perforated Viscus Repair Is Feasible Using Lower Peritoneal Pressures than Laparoscopy in a Porcine Model - Corrected ProofErica A. Moran, Christopher J. Gostout, Andrea L. McConico, Juliane Bingener10.1016/j.jamcollsurg.2009.11.014Journal of the American College of Surgeons (2010)2010-02-01Journal of the American College of Surgeons2010-02-01ORIGINAL SCIENTIFIC ARTICLE