Transvaginal repair of a large chronic porcine ventral hernia with synthetic mesh using NOTES

• Published in: Journal of the Society of Laparoendoscopic Surgeons 2010-04, Vol.14 (2), p.234-239
• Main Authors: Powell, Ben, Whang, Susan H, Bachman, Sharon L, Astudillo, J Andres, Sporn, Emanuel, Miedema, Brent W, Thaler, Klaus
• Format: Article
• Language: English
• Subjects: Animals; Colpotomy; Endoscopy - methods; Feasibility Studies; Female; Hernia, Ventral - surgery; Pneumoperitoneum, Artificial; Scientific Papers; Surgical Mesh; Swine; Vagina
• ISSN: 1086-8089; 1938-3797
• DOI: 10.4293/108680810X12785289144313

Ventral incisional hernias still remain a common surgical problem. We tested the feasibility of transvaginal placement of a large synthetic mesh to repair a porcine hernia. Seven pigs were used in this survival model. Each animal had creation of a 5-cm hernia defect and underwent a transvaginal repair of the defect with synthetic mesh. A single colpotomy was made using a 12-cm trocar for an overtube. The mesh was cut to size and placed through the trocar. A single-channel gastroscope with an endoscopic atraumatic grasper was used for grasping sutures. Further fascial sutures were placed every 5 cm. Mesh repair was feasible in all 7 animals. Mean operative time was 133 minutes. Technical difficulties were encountered. No gross contamination was seen at the time of necropsy. However, 5 animals had positive mesh cultures; 7 had positive cultures in the rectouterine space in enrichment broth or on direct culture. Transvaginal placement of synthetic mesh to repair a large porcine hernia using NOTES is challenging but feasible. Future studies need to be conducted to develop better techniques and determine the significance of mesh contamination.