The Use of Natural Orifice Transluminal Endoscopic Surgery (NOTES) in Diverticular Disease
Date
2024
Authors
Clark, Molly Ann
Editors
Advisors
Barker, Timothy Hugh
Kong, Joseph (Department of General Surgery, Alfred Health, Melbourne, Vic, Australia)
Kong, Joseph (Department of General Surgery, Alfred Health, Melbourne, Vic, Australia)
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Thesis
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Abstract
Diverticulitis refers to inflammation of the outpouching of the bowel wall or diverticula which can have various symptoms with varying degrees of severity. This inflammation can have a range of complications associated, leading to significant morbidity in patients with complicated diverticulitis (including abscess, perforation, and feculent peritonitis). The prevalence of diverticular disease and its subsequent impact has substantial significance, given that the rates of colonic diverticulosis are increasing in the Western world. Traditional diverticulitis management is guided by the level of severity with simple diverticulitis largely treated with symptomatic management with analgesia and broad-spectrum antibiotics. Complex diverticulitis can be managed with surgical resection of the affected section of the bowel, through a laparotomy approach or a laparoscopic approach. However, these surgical techniques can have a range of complications associated. In comparison, natural orifice transluminal endoscopic surgery (NOTES) refers to the use of a transanal or transvaginal approach to gain surgical access to the abdomen/peritoneal cavity, with the specimen extraction through transanal or transvaginal access (referred to as natural orifice specimen extraction (NOSE)). This minimally invasive technique has been suggested as an alternative to traditional techniques, as a means of minimising post-operative complications. The objective of this review was to assess the prevalence of intra and postoperative complications using NOTES/hybrid NOTES approach compared to traditional approaches in adult patients requiring surgical intervention for diverticulitis. This included patients of all genders and both the transanal and transvaginal NOTES approaches. Electronic databases, grey literature databases and trial registers were searched for publications comparing NOTES to laparoscopic/open/robotic/hybrid in adult patients with diverticulitis undergoing surgical intervention. There were no limitations on language or date (to the present date). An initial literature search was completed. Subsequently, two independent reviewers conducted the title/abstract and full-text screening, assessed methodological quality using the Cochrane Risk of Bias tool and extracted data using an extraction tool. Data was either pooled for statistical meta-analysis with either a random-effects or fixed-effects model and where this was not possible, a narrative presentation of findings was reported.
School/Discipline
School of Public Health
Dissertation Note
Thesis (M.Clin.Sc) -- University of Adelaide, School of Public Health, 2024
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