Revisional anti-reflux surgery is complex. The most common revisional procedure following anti-reflux surgery is redo-fundoplication; however, there is a rate of diminishing return for each subsequent redo-fundoplication. In addition, postoperative complications involving the gastroesophageal junction or intraoperative complications may require resection of the gastroesophageal junction and reconstruction. There is limited data evaluating the options for patients undergoing resectional surgery following ARS, but this paper will review the current literature and provide an overview on the indications and reconstructive options following gastro-esophageal junction resection.
Background: The Achilles heel of antireflux surgery is hiatal hernia recurrence, and no treatment modalities to date have improved this outcome. Platelet-rich plasma (PRP) is an autologous therapy that promotes wound healing by upregulating extracellular matrix proteins, and it has excellent results in numerous surgical fields. Animal studies evaluating PRP use in hiatal hernia repair show favorable outcomes, yet its application in hiatal hernia repair in humans has not been described. Methods: This is a feasibility study of patients with large (>5 cm) paraesophageal hernia (PEH) who underwent PEH repair with PRP from 2/2021 to 1/2022. Safety, feasibility, and postoperative outcomes were investigated. Results: PRP was successfully administered during PEH repair in 12 consecutive patients. There were no significant adverse events. The methods for applying PRP to the repair were modified several times to optimize the technique. Administering PRP added an average of 5 minutes to the operative time. There were no significant postoperative complications or hernia recurrence on diagnostic imaging at latest follow up, with good subjective reflux control. Conclusion: PRP has excellent clinical outcomes in other surgical fields and may become an important new adjunct in antireflux surgery. This study shows PRP is safe and feasible in PEH repair, with little effect on operative time.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.