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NOTES Transgastric Ventral Hernia Repair in a Porcine Survival Model
*Maria C Mora1,2, *Rebecca Kowalski1,2, *David J Desilets1,2, John R Romanelli1,2, *David B Earle1,2
1Baystate Medical Center, Springfield, MA;2Tufts University School of Medicine, Springfield, MA
Objective: Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive technique, which has been applied to multiple procedures. We aimed at demonstrating that a hernia repair can be effectively performed in a porcine model utilizing a transgastric NOTES approach.
Design: Intervention Study: before-after trial
Setting: Not Applicable
Patients: Not Applicable
Interventions: Ten Yorkshire pigs (weight 30-50kg) were utilized for this study. The animals underwent general anesthesia for the procedure and were prepped sterilely. Utilizing a percutaneous endoscopic gastrostomy technique, an opening was created in the greater curvature of the stomach. A balloon was used to dilate the gastrostomy, allowing the endoscope to enter the peritoneal cavity. A clean wire was introduced into the peritoneum and removed orally allowing secure access to the peritoneal cavity. Our mesh delivery system (prepared on sterile table) was introduced into the peritoneal cavity over the wire. The mesh was then secured to the abdominal wall using the pre-placed sutures and endoscopic tacks. The gastrostomy was closed with a Padlock-G™.
Main Outcome Measures: Survival; Infection; Mesh Incorporation
Results: There was a survival rate of 80% for this study. At necropsy one animal was found have gastrostomy closure failure, the other animal died within 48 hours of unknown etiology. The first mesh was found to have abscess collections at suture sites, and the second was contaminated but without gross infection. The remaining pigs had mesh that was free of contamination and infection. The mesh at two-weeks was well incorporated in all animals.
Conclusions: Hernia repair via a transgastric NOTES approach in a porcine survival model is feasible. Contamination was eliminated after introducing iodine flushing of therapeutic endoscopic channels; making this a feasible method for hernia repair.
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