Laparoscopic Paraesophageal Hernia Repair with Acellular Dermal Matrix Cruroplasty

Df, Diaz; Js, Roth

doi:10.4293/108680811x13125733356594

Cited by 22 publications

(17 citation statements)

References 21 publications

(27 reference statements)

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“…Interestingly, this recent study shows a very high recurrence rate (54–59%) for both groups . Other studies have shown benefit of using an absorbable, biologic mesh to buttress the repair of large (>5 cm) hiatal hernias …”

Section: Introductionmentioning

confidence: 69%

“…All patients completed a preoperative symptom score questionnaire recording esophageal and throat complaints of chest pain, heartburn, regurgitation, dysphagia, aspiration, and hoarseness which has been developed and validated by multiple authors. [20][21][22][24][25][26][27][28] They were asked to grade the frequency of symptoms on the following scale: 0 = never, 1 = once/month, 2 = once/week, 3 = daily, 4 = several times daily. For values between two data points, score was assigned to the higher value.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

“…21 Other studies have shown benefit of using an absorbable, biologic mesh to buttress the repair of large (>5 cm) hiatal hernias. 22 The role of biologic mesh in large PEH is still evolving as shown in a recent survey which revealed severe heterogeneity in preferred technique of PEH repair. 23 The management of hiatal hernias especially less than 5 cm as is commonly associated with antireflux surgery poses an interesting challenge.…”

Section: Introductionmentioning

confidence: 99%

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Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias

et al. 2013

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The utility of mesh reinforcement for small hiatal hernia found especially during antireflux surgery is unknown. Initial reports for the use of biological mesh for crural reinforcement during repair for defects greater than 5 cm have been shown to decrease recurrence rates. This study compares patients with small hiatal hernias who underwent onlay biologic mesh buttress repair versus those with suture cruroplasty alone. This is a single-institution retrospective review of all patients undergoing repair of hiatal hernia measuring 1-5 cm between 2002 and 2009. The patients were evaluated based on surgical repair: one group undergoing crural reinforcement with onlay biologic mesh and other group with suture cruroplasty only. Seventy patients with hiatal hernia measuring 1-5 cm were identified. Thirty-eight patients had hernia repair with biologic mesh, and 32 patients had repair with suture cruroplasty only. Recurrence rate at 1 year was 16% (5/32) in patients who had suture cruroplasty only and 0% (0/38) in the group with crural reinforcement with absorbable mesh (statistically significant, P = 0.017). Suture cruroplasty alone appears to be inadequate for hiatal hernias measuring 1-5 cm with significant recurrence rate and failure of antireflux surgery. Crural reinforcement with absorbable mesh may reduce hiatal hernia recurrence rate in small hiatal hernias.

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Section: Introductionmentioning

confidence: 69%

Section: Preoperative Evaluationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias

et al. 2013

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“…Wisbach [26] found 1 radiologic recurrence in 11 patients having paraesophageal hernia repair with allograft at mean 1-year follow-up. Diaz [27] found 2/46 symptomatic recurrences, and 2/26 radiologic recurrences, in patients undergoing paraesophageal hernia repair with allograft reinforcement (Allomax) with 3.6-month follow-up [27]. Of note, no erosions were observed in any of these studies.…”

Section: Discussionmentioning

confidence: 99%

Allograft dermal matrix hiatoplasty during laparoscopic primary fundoplication, paraesophageal hernia repair, and reoperation for failed hiatal hernia repair

2013

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BackgroundHiatal repair failure is the nemesis of laparoscopic paraesophageal hernia repair as well as the major cause of failure of primary fundoplication and reoperation on the hiatus. Biologic prosthetics offer the promise of reinforcing the repair without risks associated with permanent prosthetics.DesignRetrospective evaluation of safety and relative efficacy of laparoscopic hiatal hernia repair using an allograft (acellular dermal matrix) onlay. Patients with symptomatic failures underwent endoscopic or radiographic assessment of hiatal status.ResultsGreater than 6-month follow-up was available for 252 of 450 consecutive patients undergoing laparoscopic allograft-reinforced hiatal hernia repair between January 2007 and March 2011. No erosions, strictures, or persisting dysphagia were encountered. Adhesions were minimal in cases where reoperation was required. Failure of the hiatal repair at median 18 months (6–51 months) was significantly (p < 0.005) different between groups: group A (primary fundoplication with axial hernia ≤ 2 cm), 3.7 %; group B (primary fundoplication with axial hernia 2–5 cm), 7.1 %; group G (giant/paraesophageal), 8.8 %; group R (reoperative), 23.4 %. Additionally, mean time to failure was significantly shorter in group R (247 days) compared with the other groups (462–489 days).ConclusionsUse of allograft reinforcement to the hiatus is safe at 18 months median follow-up. Reoperations had a significantly higher failure rate and shorter time to failure than the other groups despite allograft, suggesting that primary repairs require utmost attention and that additional techniques may be needed in reoperations. Patients with hiatal hernias >2 cm axially had a recurrence rate equal to that of patients undergoing paraesophageal hiatal hernia repair, and should be treated similarly.

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“…Use of biologic materials, including acellular human dermis, has shown safe and effective results [10][11][12]. However, direct comparative studies evaluating biologic reinforcement do not exist.…”

mentioning

confidence: 98%

Effect of acellular human dermis buttress on laparoscopic hiatal hernia repair

et al. 2014

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Laparoscopic Paraesophageal Hernia Repair with Acellular Dermal Matrix Cruroplasty

Abstract: This study suggests that laparoscopic paraesophageal hernia repair with acellular dermal matrix Cruroplasty is an effective method of repairing symptomatic paraesophageal hernias with a low perioperative morbidity.

Cited by 22 publications

References 21 publications

Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias

Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias

Allograft dermal matrix hiatoplasty during laparoscopic primary fundoplication, paraesophageal hernia repair, and reoperation for failed hiatal hernia repair

Effect of acellular human dermis buttress on laparoscopic hiatal hernia repair

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