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NOTES Transgastric Ventral Hernia Repair in a Porcine Survival Model
Maria Carmen Mora MD1; Rebecca Kowalski MD1; David J. Desilets MD2; John R Romanelli MD1; David B. Earle, MD1
1Baystate Medical Center, Department of Surgery, Tufts University School of Medicine, Springfield, MA; 2Baystate Medical Center, Department of Medicine, Division of Gastroenterology, Tufts University School of Medicine, Springfield, MA

Background: To demonstrate that a hernia repair can be effectively performed in a porcine survival model utilizing a transgastric NOTES approach without gross contamination.

Methods: Ten Yorkshire pigs were utilized for this study; they underwent general anesthesia for the procedure and were prepped sterilely. Utilizing a PEG technique, an anterior gastrotomy was created, which was then balloon dilated to allow 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 was then introduced into the peritoneal cavity over the wire. The mesh was secured to the abdominal wall using pre-placed sutures and endoscopic tacks. The gastrostomy was closed with a Padlock-G.

Results: There was a survival rate of 80% for this study. One animal was euthanized on POD3 secondary to sepsis and was found have a gastrostomy closure failure; the other died within 24 hours of unknown etiology. The first mesh was found to have abscesses at the suture sites; the second was contaminated but without gross infection. Subsequently, the therapeutic channels were flushed with povidone-iodine, and all remaining pigs had mesh incorporated onto the abdominal wall without contamination and infection.

Conclusion: Hernia repair via a transgastric NOTES approach in a porcine survival model is feasible, and can be performed without contamination or infection to the mesh.

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