Surgical treatment of large and complicated hiatal hernias with the new resorbable mesh with hydrogel barrier (Phasix™ ST): a preliminary study

Konstantinidis, Haris; Charisis, Christos

doi:10.1007/s11701-022-01406-9

Cited by 7 publications

(4 citation statements)

References 29 publications

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“…The present study is currently the largest reporting on BSM augmentation in HH repair and adds further evidence to the existing literature. Similar to earlier series using P4HB patches [ 17 – 19 ], we observed no severe mesh-related intra- and perioperative morbidity, and clinical results after mid- and long-term follow-up were encouraging with good functional results, a low objective recurrence rate and no evidence of erosions or stenosis. In agreement with the previously published experience, we may therefore conclude that BSM with P4HB patches can be safely performed at the hiatus.…”

Section: Discussionsupporting

confidence: 88%

“…Phasix ST® (BD, Allschwil, Switzerland) is made from poly-4-hydroxybutyrate (P4HB), a material that handles well laparoscopically, absorbs and remodels to native host tissue within 6–18 months [ 15 , 16 ], and should therefore carry a lower risk of long-term complications. Although promising in concept, only few studies have reported clinical outcomes after P4HB reinforcement in HH repair [ 17 – 19 ]. Hence, the aim of this study was to analyze our institutional experience with this new generation of mesh.…”

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confidence: 99%

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Hiatus hernia repair with a new-generation biosynthetic mesh: a 4-year single-center experience

et al. 2023

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Background Mesh augmentation is a highly controversial adjunct of hiatus hernia (HH) surgery. The current scientific evidence remains unclear and even experts disagree on indications and surgical techniques. With an aim to avoid the downsides of both non-resorbable synthetic and biological materials, biosynthetic long-term resorbable meshes (BSM) have recently been developed and are becoming increasingly popular. In this context, we aimed at assessing outcomes after HH repair with this new generation of mesh at our institution. Methods From a prospective database, we identified all consecutive patients that underwent HH repair with BSM augmentation. Data was extracted from electronic patient charts of our hospital information system. Endpoints of this analysis included perioperative morbidity, functional results and recurrence rates at follow-up. Results Between December 2017 and July 2022, 97 patients (elective primary cases n = 76, redo cases n = 13, emergency cases n = 8) underwent HH with BSM augmentation. Indications in elective and emergency cases were paraesophageal (Type II–IV) HH in 83%, and large Type I HH in 4%. There was no perioperative mortality, and overall (Clavien–Dindo ≥ 2) and severe (Clavien–Dindo ≥ 3b) postoperative morbidity was 15% and 3%, respectively. An outcome without postoperative complications was achieved in 85% of cases (elective primary surgery 88%, redo cases 100%, emergencies cases 25%). After a median (IQR) postoperative follow-up of 12 months, 69 patients (74%) were asymptomatic, 15 (16%) reported improvement, and 9 (10%) had clinical failure, of which 2 patients (2%) required revisional surgery. Conclusion Our data suggest that HH repair with BSM augmentation is feasible and safe with low perioperative morbidity and acceptable postoperative failure rates at early to mid-term follow-up. BSM may be a useful alternative to non-resorbable materials in HH surgery.

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Section: Discussionsupporting

confidence: 88%

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confidence: 99%

Hiatus hernia repair with a new-generation biosynthetic mesh: a 4-year single-center experience

et al. 2023

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“…A small number of studies ( n = 2 in each group) evaluated P4HB mesh for incisional hernia prophylaxis ( 27 , 54 ) and inguinal hernia repair ( Table 1 , and Table 2 ) ( 11 , 28 ). Several studies ( n = 5) also explored the use of P4HB mesh in hiatal/paraesophageal hernia repair ( Table 1 , and Table 2 ) ( 29 , 57 , 58 , 79 , 80 ). These studies reported favorable clinical outcomes, including low hernia recurrence rates (range: 0%–8%) and no surgical site infections (SSI), mesh-related complications, or reoperations with follow-up periods of at least 1 year.…”

Section: Resultsmentioning

confidence: 99%

Fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for soft tissue repair and reconstruction: A scoping review

et al. 2023

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BackgroundPoly-4-hydroxybutyrate (P4HB) is a fully resorbable, biologically-produced polymer with a strength and flexibility comparable to permanent synthetic polymers. The objective was to identify/summarize all peer-reviewed publications involving P4HB mesh.MethodsA scoping review was conducted within PubMed and included articles published through October 2022.ResultsA total of n = 79 studies were identified (n = 12 in vitro/bench; n = 14 preclinical; n = 6 commentaries; n = 50 clinical). Of the clinical studies, n = 40 reported results applicable to hernia and n = 10 to plastic/reconstructive surgery and involved patients of all Centers for Disease Control (CDC) wound classes and Ventral Hernia Working Group (VHWG) grades.ConclusionP4HB mesh provides long-term hernia repair strength and exhibits promising clinical outcomes beyond its resorption period. Future studies should include randomized controlled trials comparing P4HB to other biomaterials, as well as optimal patient selection, operative technique, long-term outcomes, minimization of potential mesh-related complications, and potential contraindications/complications for P4HB in hernia/abdominal wall reconstruction.

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“…Hydrogels, with simple composition [ 22 , 23 ] or chemically modified or physically doped, can produce adhesive and tough hydrogels, which can be used for tissue regeneration including hernia. Due to the relatively weak mechanical strength, hydrogels are used as surface coatings to reduce tissue adhesion or increase the biocompatibility of hernia repair materials [ 24 , 25 ]. Electrospinning, on the other hand, has emerged as a leading strategy in tissue engineering to fabricate fibrous membranes with large surface-area-to-volume ratios and nano-to-micro-sized fibers [ 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Abdominal wall hernia repair: from prosthetic meshes to smart materials

Saiding,

Chen,

Wang

et al. 2023

Materials Today Bio

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Surgical treatment of large and complicated hiatal hernias with the new resorbable mesh with hydrogel barrier (Phasix™ ST): a preliminary study

Cited by 7 publications

References 29 publications

Hiatus hernia repair with a new-generation biosynthetic mesh: a 4-year single-center experience

Hiatus hernia repair with a new-generation biosynthetic mesh: a 4-year single-center experience

Fully resorbable poly-4-hydroxybutyrate (P4HB) mesh for soft tissue repair and reconstruction: A scoping review

Abdominal wall hernia repair: from prosthetic meshes to smart materials

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