The feasibility of FS mesh fixation by a transgastric approach--an important benefit in future NOTES procedures?
BACKGROUND
Preserving the integrity of the abdominal wall is a major benefit in NOTES procedures. It may result in a decrease of postoperative (postOP) pain, infection, and port site hernia. This experimental study on intra-peritoneal onlay mesh (IPOM) repair was designed to apply meshes by a transgastric access (TGA) and to use a combination of transfascial sutures and fibrin sealant as fixation.


METHODS
Four abdominal wall defects were created by TGA under laparoscopic control in five nonsurvival and three survival pigs (4, 11, and 22 d observation period). Titanized polypropylene meshes were fixed transfascially by four polypropylene sutures using a "suture passer" device. Meshes were additionally fixed with 0.2 mL of fibrin sealant (FS) by an endoscopic application. TGA was closed with endoclips in the nonsurvival model and with laparoscopic suturing in survival pigs.


RESULTS
The three survival pigs were euthanized on the d 4, 11, and 22 postOP. The macroscopic evaluation revealed excellent integration of the meshes without signs of shrinkage, dislocation, or inflammation. Histology confirmed macroscopic findings.


CONCLUSIONS
Our findings confirm that IPOM repair of ventral hernia in an experimental NOTES hybrid procedure is feasible. This study also demonstrates the technical feasibility and the potential advantages of FS mesh fixation to further reduce trauma to the abdominal wall following the key principles of the NOTES approach.
Fortelny
René H
RH
II Department of General Surgery, Wilhelminenspital, Vienna, Austria.
Petter-Puchner
Alexander H
AH
Gruber-Blum
Simone
S
Mika
Kathrin
K
Brand
Julian
J
Keibl
Claudia
C
Glaser
Karl S
KS
Redl
Heinz
H
D058107:Abdominal Wound Closure Techniques; D000818:Animals; D004724:Endoscopy / Q000379:methods; D000071938:Fasciotomy; D005240:Feasibility Studies; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology*; D006555:Hernia, Ventral / Q000601:surgery*; D007249:Inflammation / Q000473:pathology / Q000517:prevention & control; D011183:Postoperative Complications / Q000473:pathology / Q000517:prevention & control*; D013270:Stomach; D013526:Surgical Mesh; D034421:Sus scrofa; D013536:Suture Techniques; D000267:Tissue Adhesions / Q000473:pathology / Q000517:prevention & control; D014014:Tissue Adhesives / Q000494:pharmacology
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives