Can gastric irrigation prevent infection during NOTES mesh placement?

Area of Science:

• Minimally Invasive Surgery
• Surgical Innovation
• Gastroenterology

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) offers a scarless approach to ventral hernia repair.
• Mesh placement in NOTES procedures raises concerns regarding infection risk.
• This study compares infection rates between NOTES and laparoscopic mesh placement.

Purpose of the Study:

• To evaluate the feasibility and safety of mesh placement in NOTES ventral hernia repair.
• To compare the infectious complication rates of NOTES mesh placement versus traditional laparoscopic mesh placement.
• To identify factors influencing infection risk in NOTES procedures.

Main Methods:

• Thirty-seven swine underwent randomized abdominal wall mesh placement via NOTES or laparoscopy, or served as NOTES controls.
• All animals received antibiotics and gastric irrigation; some received acid suppression.
• Mesh was transgastrically delivered and secured; necropsy was performed at 14 days.

Main Results:

• NOTES mesh placement was technically feasible in most cases.
• A significantly higher rate of mesh infection was observed in the NOTES group compared to the laparoscopic group (4:11 vs 0:14; p = 0.03).
• Gastric irrigation effectively reduced bacterial load but did not correlate with infection rates.

Conclusions:

• While technically feasible, NOTES mesh placement for ventral hernia repair is associated with a high infection rate.
• Sterile conduits are necessary to mitigate infection risk and enable safe NOTES mesh repair.
• Further technological advancements are required for widespread adoption of NOTES in hernia surgery.