Transgastric biologic mesh delivery and abdominal wall hernia repair in a porcine model

Abstract

Transgastric repair of a chronic ventral hernia is technically feasible. Difficulties with mesh delivery and infection need to be overcome before this approach can be used in humans.

Natural-orifice transluminal endoscopic surgery

“…There have been other novel applications of NOTES, including both transgastric and transvaginal ventral hernia repair. A major concern with this approach, however, is bacterial contamination of prosthetic mesh.…”

Feasibility of Transumbilical Flexible Endoscopic Preperitoneoscopy (FLEPP) and Its Utility for Inguinal Hernia Repair

“…Besides hernia, preperitoneal approaches have been used for other surgical procedures, such as prostatectomies, surgery of urinary bladder diverticuli, 4 treatment of osteitis pubis, 5 varicocelectomy for male-factor infertility, 6 and so on. The natural orifice translumenal endoscopic surgery (NOTES) approach for abdominal wall hernia repair has been widely studied in animal models, [7][8][9][10][11][12][13][14] and it has also been described in a human case. 15 NOTES inguinal hernia repair by intraperitoneal onlay meshplasty (IPOM) 16,17 has been reported in some animal experiments.…”

Improving the Antibacterial Property of Porcine Small Intestinal Submucosa by Nano-Silver Supplementation

“…4 In the natural orifice transluminal endoscopic surgery (NOTES) for ventral hernia repair with PSIS or PPBM via a total transgastric approach, animals usually had trouble with the culture-positive abscess (60-100%) or infection (100%) despite use of gastric irrigation, proton pump inhibitor, prophylactic antibiotics and sterile overtubes, which likely resulted from exposing to bacteria in the stomach. [5][6][7] In addition, although Surgisis R , a 4-or 8-ply biological mesh derived from PSIS, had been shown to be safely utilized for patients undergoing laparoscopic or open repair of ventral hernias in clean, clean contaminated and contaminated cases, the postoperative recurrence rate has been found to be 50% in the contaminated cases. The recurrences all occurred in the contaminated patients, and one of recurrent patient had ongoing postoperative sepsis and had the mesh removed.…”