Endoscopy 2007; 39(10): 865-869
DOI: 10.1055/s-2007-966916
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Transcolonic ventral wall hernia mesh fixation in a porcine model

D.  G.  Fong1 , M.  Ryou1 , R.  D.  Pai1 , A.  Tavakkolizadeh2 , D.  W.  Rattner3 , C.  C.  Thompson4
  • 1Division of Gastroenterology and Hepatology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  • 2Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  • 3Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
  • 4Division of Gastroenterology/Therapeutic Endoscopy Group, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Weitere Informationen

Publikationsverlauf

submitted 22 August 2007

accepted after revision 8 September 2007

Publikationsdatum:
29. Oktober 2007 (online)

Background and study aims: A natural orifice transluminal endoscopic surgery (NOTES) approach to ventral wall hernia repair may represent a potentially less invasive alternative to current transabdominal surgical techniques. We aimed to investigate the feasibility of using transcolonic NOTES to deliver hernia repair mesh into the peritoneal cavity, as well as the ability to manipulate composite mesh and secure it to the abdominal wall.

Methods: Five pigs weighing 20 to 25 kg were used in this feasibility study involving two acute and three survival experiments. A prototype mesh delivery system was used to transfer 1.5 - 2-cm × 2.5 - 3-cm pieces of composite hernia mesh into the peritoneal cavity. Neodymium magnets on a prototype control arm were used to help position the mesh by magnetically engaging previously placed endoscopic clips. Transfascial fixation of the mesh with 3-0 monofilament sutures was achieved using a 19-gauge hollow needle, pusher wire, and a suture tag system.

Results: Composite hernia mesh was successfully transferred and secured in 5/5 attempts. All three survival animals thrived for 14 days prior to elective sacrifice. At necropsy, the mesh sites were found to be well peritonealized without adhesions. Suture placement through the posterior fascia was confirmed in 10/12 sutures. Of these, four sutures were within the abdominal musculature, and two sutures were through the anterior fascia (transfascial).

Conclusions: Transcolonic delivery, transcutaneous magnetic manipulation, and fixation of composite hernia mesh are technically feasible in a porcine model with animal survival. An effective suturing method that allows consistent anchoring through the anterior fascia would be preferred and may require the development of novel devices.

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C. C. Thompson, MD

Brigham and Women’s Hospital

Division of Gastroenterology

75 Francis St

Boston, MA, 02115

USA

Fax: +1-617-732-8266

eMail: ccthompson@partners.org