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Surgical Endoscopy

, Volume 29, Issue 12, pp 3712–3716 | Cite as

Hybrid NOTES transvaginal intraperitoneal onlay mesh in abdominal wall hernias: an alternative to traditional laparoscopic procedures

  • Alexandre DesclouxEmail author
  • Sebastian Pohle
  • Antonio Nocito
  • Andreas Keerl
Article

Abstract

Introduction

Abdominal wall hernias are increasingly treated by laparoscopic placement of an intraperitoneal onlay mesh (IPOM). We present an alternative technique for women: the laparoscopic-assisted transvaginal IPOM.

Methods

Before surgery, all patients underwent a gynecological examination. The patients agreed to IPOM repair via a transvaginal approach, and written informed consent for surgery was obtained. Pneumoperitoneum was established with a Veress needle at the umbilicus. This access was subsequently dilated to 5 mm (VersaStep), and a 5-mm laparoscope was inserted. Under laparoscopic view, the transvaginal trocars (12-mm VersaStep and 5-mm flexible accesses) were safely inserted after lifting the uterus with a uterus manipulator. After preparation of the falciform ligament, the ligamentum teres and the preperitoneal fat, a lightweight composite mesh was introduced through the transvaginal access and fixed with absorbable tacks using the double-crown technique.

Results

From September 2011 to December 2012, we performed six laparoscopic-assisted transvaginal IPOM procedures (one epigastric, three umbilical, two combined epigastric and umbilical hernias; all were primary hernias). In the initial phase, only patients with small or medium primary abdominal wall hernia were selected (max. 3 cm diameter). Median hospital stay was 3 days (range 2–6 days). One minor complication occurred perioperatively (second-degree skin burn to the labia majora). At 1-year follow-up, we identified one recurrence in a high-risk patient with a body mass index higher than 35 kg/m2. No infection and no mortality were observed.

Conclusion

Although no final conclusion can be made regarding the presumed non-inferiority of this technique in terms of recurrence and mesh infection compared with traditional laparoscopic IPOM, laparoscopic-assisted transvaginal IPOM is a feasible alternative to treat abdominal wall hernias.

Keywords

Transvaginal NOTES Mesh IPOM Abdominal wall hernia 

Notes

Disclosures

Alexandre Descloux, Sebastian Pohle, Antonio Nocito and Andreas Keerl have no conflict of interest to declare.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Alexandre Descloux
    • 1
    Email author
  • Sebastian Pohle
    • 1
  • Antonio Nocito
    • 1
  • Andreas Keerl
    • 1
  1. 1.Department of SurgeryKantonsspital BadenBadenSwitzerland

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