Combination of Surgical Technique and Bioresorbable Mesh Reinforcement of the Crural Repair Leads to Low Early Hernia Recurrence Rates with Laparoscopic Paraesophageal Hernia Repair

Abdelmoaty, Walaa; Dunst, Christy M.; Filicori, Filippo; Zihni, Ahmed M.; Davila-Bradley, Daniel; Reavis, Kevin M.; Swanström, Lee L.; DeMeester, Steven R.

doi:10.1007/s11605-019-04358-y

Cited by 40 publications

(22 citation statements)

References 14 publications

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“…13,38 Recently, encouraging outcomes of laparoscopic PEH repair with the use of newer biosynthetic absorbable mesh (Poly-4-hydroxybutyrate; Phasix-St-mesh) has been reported. 24 The combination of mesh reinforcement and other tension-reducing techniques in that study resulted in a low rate of hernia recurrence and no mesh-related complications at short term follow up. However, selective mesh reinforcement is unlikely to overcome extensive hiatal tension.…”

Section: Discussionmentioning

confidence: 72%

“…23 Sliding hiatal hernias are still much more common than paraesophageal hernias, but the prevalence of the latter seems to be increasing in the United States. 24 In patients with type I hiatal hernias the esophagogastric junction has migrated above the level of the diaphragm whereas in those with paraesophageal hernias, there is relative preservation of posterolateral phrenoesophageal attachments around the EGJ. 25 The inherent differences of paraesophageal and large siding hernias result in varying disease manifestation, necessity for speci c surgical maneuvers and forms of postoperative failure.…”

Section: Discussionmentioning

confidence: 99%

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Magnetic Sphincter Augmentation In Patients With Paraesophageal Hernia Vs. Large Sliding Hiatal Hernia: Comparison of Clinical Outcome And Complexity Of The Surgery

Schwameis

Ayazi

Zheng

et al. 2021

Preprint

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Introduction: Recent studies encourage the use of magnetic sphincter augmentation (MSA) in patients with large sliding hiatal hernia (LHH). However, the utility of MSA in patients with paraesophageal hernia (PEH) is poorly studied. The aim of this study is to compare the outcome and complexity of surgery in patients with PEH to those with LHH. Methods: A total of 37 (65% female) patients underwent PEH repair with MSA in our institution between 2013 and 2019. A group of 37, age/sex matched patients with LHH (≥ 4 cm) who underwent MSA formed the control group. The clinical outcome and the complexity of the surgery were then compared between groups. Results: At a median follow-up of 25.3 (17–35) months, there was significant improvement in the GERD-HRQL total-scores for PEH (18 vs. 3, p < 0.001) and LHH (26 vs. 4, p < 0.0001) patients when compared to preoperative values. The PEH group was similar to LHH group in regard to pH-normalization (71% vs. 64%, p = 0.76) and freedom from PPI (94.4% vs. 91.9%, p = 1.00). Small asymptomatic hernia recurrence was seen in 19% and 18% of LHH and PEH patients, respectively (p = 0.546). One patient (3%) required surgical intervention for symptomatic recurrence in each group. The rate of dysphagia and need for dilation were similar between the groups. No significant differences in operative time, blood loss, and hospital stay were detected between patients with PEH and those with LHH. However, there was a trend toward higher necessity for additional operative maneuvers (40.5% vs 13.5%, p = 00.17) and longer hospital stay in PEH. Conclusion: Despite the inherent differences between LHH and PEH, repair of hernia and MSA results in high rate of favorable outcome and low rate of recurrence in both groups. GERD symptom control, freedom from PPI and improvement in quality of life are comparable. However, the greater need for additional surgical maneuvers and longer hospital stay reflect the greater complexity of procedures for repair of PEH with MSA.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Magnetic Sphincter Augmentation In Patients With Paraesophageal Hernia Vs. Large Sliding Hiatal Hernia: Comparison of Clinical Outcome And Complexity Of The Surgery

Schwameis

Ayazi

Zheng

et al. 2021

Preprint

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“…Similar results were recently published by Dr. DeMeester's group using NoneCross-linked human dermal mesh 27 or Phasix Sepra-Technology (Phasix-ST mesh). 28 Oelschlager et al reported the longest follow up after using biological mesh for large paraesophageal hiatal hernia. 29 Unfortunately, their results proved that the benefit in reducing large hiatal hernia recurrence diminishes at long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

Robotic Fundoplication for Large Paraesophageal Hiatal Hernias

Arcerito

Perez

Kaur

et al. 2020

JSLS

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Purpose: Laparoscopic fundoplication is now a cornerstone in the treatment of gastro-esophageal reflux disease (GERD) with sliding hernia. The best outcomes are achieved in those patients who have some response to medical treatment compared to those who do not. Robotic fundoplication is considered a novel approach in treating GERD with large paraesophageal hiatal hernias. Our goal was to examine the feasibility of this technique. Methods: Seventy patients (23 males and 47 females) with mean age 64 y old (22-92), preoperatively diagnosed with a large paraesophageal hiatal hernia, were treated with a robotic approach. Biosynthetic tissue absorbable mesh was applied for hiatal closure reinforcement. Fifty-eight patients underwent total fundoplication, 11 patients had partial fundoplication, and one patient had a Collis-Nissen fundoplication for acquired short esophagus. Results: All procedures were completed robotically, without laparoscopic or open conversion. Mean operative time was 223 min (180-360). Mean length of stay was 38 h (24-96). Median follow-up was 29 mo (7-51). Moderate postoperative dysphagia was noted in eight patients, all of which resolved after 3 mo without esophageal dilation. No mesh-related complications were detected. There were six hernia recurrences. Four patients were treated with redo-robotic fundoplication, and two were treated medically. Conclusions: The success of robotic fundoplication depends on adhering to a few important technical principles. In our experience, the robotic surgical treatment of gastroesophageal reflux disease with large paraesophageal hernias may afford the surgeon increased dexterity and is feasible with comparable outcomes compared with traditional laparoscopic approaches.

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“…We did consider whether to include other techniques for repairing large hiatus hernias, such as oesophageal lengthening with a Collis gastroplasty and/or diaphragm-relaxing incisions [14]. However, this would add confounding factors to the procedure.…”

Section: Treatment Groupsmentioning

confidence: 99%

“…One expert centre initially reported low recurrence rates of 6% with this; however, this rose to 24% at 2 years, and 50% by 10 years [11][12][13]. For these reasons, other surgical techniques have been sought to improve the durability of sutureonly repairs, including Collis gastroplasty to lengthen the oesophagus and diaphragm-relaxing incisions [14].…”

Section: Introductionmentioning

confidence: 99%

Protocol for Randomised Controlled Feasibility Study Comparing Cruroplasty with Circumferential DynaMesh-HIATUS® Versus Suture-Only Repair for Large Hiatus Hernias

Darbyshire

Mátyus

Fogg

et al. 2020

SN Compr. Clin. Med.

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Laparoscopic fundoplication has become a standard surgical treatment for gastro-oesophageal reflux disease. Many of these patients also have a hiatus hernia that is repaired at the same time. However, suture-only repair of larger hiatus hernias has recurrence rates as high as 50%. Evidence on the effectiveness and safety of surgical mesh to reinforce hiatal repair compared with suture-only repair is currently lacking. This study aims to assess the feasibility of running a randomised controlled trial comparing the results of large hiatus hernia repair with DynaMesh-HIATUS® crural reinforcement versus standard suture repair alone. This is a single-centre, double-blind, parallel group randomised feasibility study. Forty patients with large hiatus hernia will be randomised to standard laparoscopic suture repair or suture repair with cruroplasty using the DynaMesh-HIATUS® circumferential mesh, with a 3-year follow-up period. Participants and assessors will be blinded to treatment allocation. Outcomes include trial process indicators (eligible participants, recruitment, and retention rates), surgical indicators (placement of mesh, operative complications, length of stay), adverse events, patient quality of life and symptom scores and mesh position after 1 year, and patient quality of life measures to 3 years. Feasibility will be assessed by rates of recruitment, retention, and successful surgical procedures. Clinical and patient-related outcomes for the two surgical methods will be described, and those most appropriate to include in a definitive trial identified. Correlation will be made between the position of the mesh on magnetic resonance imaging (MRI) and clinical outcomes. The DYNAMIC study will provide information to design and deliver a definitive randomised controlled trial of DynaMesh-HIATUS® cruroplasty compared with suture repair alone.

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Combination of Surgical Technique and Bioresorbable Mesh Reinforcement of the Crural Repair Leads to Low Early Hernia Recurrence Rates with Laparoscopic Paraesophageal Hernia Repair

Cited by 40 publications

References 14 publications

Magnetic Sphincter Augmentation In Patients With Paraesophageal Hernia Vs. Large Sliding Hiatal Hernia: Comparison of Clinical Outcome And Complexity Of The Surgery

Magnetic Sphincter Augmentation In Patients With Paraesophageal Hernia Vs. Large Sliding Hiatal Hernia: Comparison of Clinical Outcome And Complexity Of The Surgery

Robotic Fundoplication for Large Paraesophageal Hiatal Hernias

Protocol for Randomised Controlled Feasibility Study Comparing Cruroplasty with Circumferential DynaMesh-HIATUS® Versus Suture-Only Repair for Large Hiatus Hernias

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