Are Surgisis Biomeshes Effective in Reducing Recurrences After Laparoscopic Repair of Large Hiatal Hernias?

Abstract

Prosthetic repair is frequently advocated after repair of large hiatal hernias, and biomeshes have been proposed to help reduce the high recurrence rate. All patients undergoing laparoscopic repair of primary or recurrent large hiatal hernia, and with intraoperative finding of weak diaphragmatic pillars, as judged by the surgeon, were included, from June 2004 to July 2005, in a prospective observational study. In these patients, Surgisis biomeshes were employed to assist the repair. Six patients (4 for primary and 2 for recurrent hernia) received biomesh hiatoplasty. Four had mild dysphagia at 1 month that disappeared at the next follow-up. Three had slow radiologic transit through the esophagogastric junction, still present in 1 patient at 1 year. One patient had hernia recurrence 6 months after surgery and 2 other patients had radiologic recurrence of a small hernia at 1-year follow-up; in all 3, the recurrence was small and asymptomatic and none were reoperated. The short-term recurrence rate using biomesh for the laparoscopic repair of large hiatal hernias in patients with weak diaphragmatic pillars was high at 50%. Postoperative morbidity and mesh-related complications were almost absent. Biomeshes can be safely used as on lay reinforcement in hiatoplasty, but do not reduce the hiatal recurrence rate.

Long-term surgical outcomes in congenital diaphragmatic hernia: observations from a single institution

“…The reasons for these latter increased risks with SIS repair are unclear but may be related to disease severity or hernia recurrence requiring repeat laparotomies and patch repairs. Some reports have shown that the material does not always provide durable defect repair in other settings and may be proinflammatory [20][21][22]. In response to these findings, our group no longer performs SIS-only repairs.…”

Laparoscopic repair of esophageal hiatal hernia

“…It is unclear whether this will confer long-term protection of recurrence. Uberto et al [13] reported an unexpectedly high (50%) recurrence rate after postoperative 1 year. Their results indicated that the biomesh does not adequately reinforce the crura and predispose to later repair failure.…”

Hiatal hernia repair with mesh: a survey of SAGES members

“…Some authors have described an intraoperative area measurement of the hiatal defect, and then utilize a closure method which is based on this measurement [31]. Others have used the radial distance from the esophagus to a crural column [32], some have used preoperative hiatal area measurement using barium radiography [33], and yet others (including us) simply use the transverse dimension to describe defect size [12]. The survey was not designed to collect data on how the surgeons measured defect size.…”