Can gastric irrigation prevent infection during NOTES mesh placement?
BACKGROUND
Natural orifice transluminal endoscopic surgery (NOTES) ventral hernia repair could avoid abdominal wall incisions. The infectious risk for mesh placement is of concern. We compared NOTES with laparoscopic mesh placement.


METHODS
Thirty-seven swine were randomized to abdominal wall polypropylene mesh placement via NOTES or laparoscopy or NOTES control. All animals received antibiotics and gastric irrigation; the laparoscopy group also received preoperative acid suppression. In the NOTES mesh group, the 2-cm(2) polypropylene mesh was placed using a transgastric transportation device and clipped to the anterior abdominal wall. The control animals underwent endoscopy (no gastrotomy) followed by laparoscopic mesh placement or NOTES only without mesh placement. Necropsy was performed at 14 days.


RESULTS
One NOTES mesh placement was incomplete (endoscope failure). All mesh animals survived to 14 days. At necropsy, significantly more mesh infections were noted in the NOTES mesh versus laparoscopy group (4:11 vs 0:14; p = 0.03). Gastric irrigation reduced the bacterial load significantly in all groups (p < 0.001). Infection was independent of gastric bacterial load. No difference between acid suppressed and non-suppressed animals was seen.


CONCLUSIONS
The mesh placement via NOTES is technically feasible but has a high infection rate despite irrigation. Sterile conduits are needed to enable NOTES-type hernia repair with mesh.
Buck
Lauren
L
Department of Surgery, University of Texas Health Science Center, San Antonio, TX, USA.
Michalek
Joel
J
Van Sickle
Kent
K
Schwesinger
Wayne
W
Bingener
Juliane
J
D034841:Abdominal Cavity / Q000382:microbiology; D000818:Animals; D001424:Bacterial Infections / Q000517:prevention & control; D004195:Disease Models, Animal; D005260:Female; D005751:Gastric Lavage; D006555:Hernia, Ventral / Q000601:surgery*; D007430:Intraoperative Care / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D019919:Prosthesis Implantation; D011897:Random Allocation; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013526:Surgical Mesh; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013552:Swine; D014472:Umbilicus