Laparoscopic surgery is increasing in popularity for repair of abdominal wall hernias. These procedures still require multiple incisions of the anterior abdominal wall, which can lead to postoperative pain, infection, and potential recurrent hernias. From a technical standpoint, it may be easier to perform abdominal wall hernia repair from a transgastric approach. AIM: To evaluate safety and feasibility of transgastric endoscopic approach for repair of abdominal wall hernias. METHODS: We performed acute experiments using 50-kg pigs. All procedures were done under general anesthesia with endotracheal intubation using sterilized endoscopes and accessories. The stomach was irrigated with an antibiotic solution, an incision through the gastric wall was made and a sterile endoscope was advanced into the peritoneal cavity. Anterior abdominal wall incision was made with a needle knife to create the animal model of an abdominal wall hernia. After hernia creation, an endoscopic suturing device (Eagle Claw, Olympus„¥) was used to close the incision. The endoscope was withdrawn into the stomach and the gastric wall incision was closed with endoscopic clips (Boston Scientific„¥). The animals were sacrificed for postmortem examination. RESULTS: 2 acute experiments were done. Incision of the gastric wall was easily performed with a needle knife and pull-type sphincterotome. A large (3 cm) incision of the abdominal wall (hernia model) was easily closed with 4-5 sutures using the endoscopic suturing device. Postmortem examination revealed complete closure of the hernia without any complications. CONCLUSION: Transgastric endoscopic repair of abdominal wall hernias is feasible and may be technically easier than laparoscopic surgery.