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

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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.

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Disclosures

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

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Authors and Affiliations

  1. Department of Surgery, Kantonsspital Baden, 5404, Baden, Switzerland

    Alexandre Descloux, Sebastian Pohle, Antonio Nocito & Andreas Keerl

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  1. Alexandre Descloux
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  2. Sebastian Pohle
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  3. Antonio Nocito
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  4. Andreas Keerl
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Correspondence to Alexandre Descloux.

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Descloux, A., Pohle, S., Nocito, A. et al. Hybrid NOTES transvaginal intraperitoneal onlay mesh in abdominal wall hernias: an alternative to traditional laparoscopic procedures. Surg Endosc 29, 3712–3716 (2015). https://doi.org/10.1007/s00464-015-4141-x

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  • DOI: https://doi.org/10.1007/s00464-015-4141-x

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