Background: Many of the characteristics of inguinal hernia repair are especially well suited to the transgastric approach. The repair is inline with the transgastric scope vector, bilateral defects are adjacent and the intraperitoneal onlay mesh (IPOM) technique does not require significant manipulation or novel instrumentation. The purpose of this study was to evaluate the safety and durability of natural orifice translumenal endoscopic surgery (NOTES) bilateral inguinal herniorrhaphy (BIH) using the IPOM technique in a survival canine model.
Materials and Methods: Under general anesthesia five male mongrel dogs weighing 20-30kgs had a dual channel endoscope introduced into the peritoneal cavity over a percutaneously placed guidewire. An overtube with an insufflation channel was used. Peritoneoscopy was performed and bilateral deep and superficial inguinal rings were identified. The scope was removed, premounted with a 4X6cm acellular dermal implant (Lifecell, Branchburg, NJ) then re-advanced intraperitoneally via the overtube. The implant was then deployed across the entire myopectineal orifice and draped over the cord structures. Bio-glue was then applied and the implant was attached to the peritoneum. Following completion of bilateral repairs the animals were survived for 14 days. At the end of the study period the animals were euthanized and 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: Five dogs underwent pure NOTES IPOM BIH. Accurate placement and adequate myopectineal coverage was accomplished in all subjects. All animals thrived postoperatively and did not manifest signs of peritonitis or sepsis at any point. No adhesions or abscesses were found related to the implant deployment site and all cultures had no growth.
Conclusions: This study confirms that NOTES IPOM BIH can be performed safely and warrants human trials.
Program Number: P259