title: Natural orifice translumenal endoscopic surgery inguinal hernia repair: a survival canine model.
abstract: BACKGROUND
  With over 20 million repairs performed worldwide annually, inguinal hernias represent a significant source of disability and loss of productivity. Natural orifice translumenal endoscopic surgery (NOTES™), as a potentially less invasive form of surgery may reduce postoperative disability and accelerate return to work. The objective of this study was to assess the safety and short-term effectiveness of transgastric inguinal herniorrhaphy using a biologic mesh in a survival canine model.
  
  
  METHODS
  Under general anesthesia with the animal in Trendelenburg position, a gastrostomy was created. A 4 × 6 cm acellular dermal implant was deployed endoscopically across the myopectineal orifice, draped over the cord structures, and secured with Bioglue. Following completion of bilateral repairs the animals were survived for 14 days. At the end of the study period, the animals were euthanized and a necropsy performed. Cultures of a random site within the peritoneal cavity and at the site of implant deployment were obtained. In addition, a visual inspection of the peritoneal cavity was performed.
  
  
  RESULTS
  All animals thrived postoperatively and did not manifest signs of peritonitis or sepsis at any point. At necropsy accurate placement and adequate myopectineal coverage was confirmed in all subjects. Cultures of a random site within the peritoneal cavity and at the site of implant deployment had no growth.
  
  
  CONCLUSIONS
  This study confirms that NOTES-inguinal herniorrhaphy using a biologic implant can be performed safely. In addition, the transgastric technique provided good short-term myopectineal coverage without infectious sequelae.
authors: Division of Minimally Invasive Surgery, Maimonides Medical Center, Brooklyn, New York, USA. dsherwinter@maimonidesmed.org
authors: Danny A
authors: DA
authors: Sherwinter
authors: Amar
authors: A
authors: Gupta
authors: Jeremy G
authors: JG
authors: Eckstein
mesh_terms: D000818:Animals; D004285:Dogs; D006552:Hernia, Inguinal / Q000601:surgery*; D008297:Male; D057605:Natural Orifice Endoscopic Surgery; D011506:Proteins / Q000627:therapeutic use; D017768:Skin, Artificial; D016896:Treatment Outcome
chemical_list: C472676:Bio-glue; D011506:Proteins