Symptomatic, Radiological, and Quality of Life Outcome of Paraesophageal Hernia Repair With Urinary Bladder Extracellular Surgical Matrix: Comparison With Primary Repair

Abstract

Introduction: Paraesophageal hernia repairs are prone to recurrence and mesh reinforcement is common. Both biologic and prosthetic meshes have been used. We report a comparison of a new type of biologically derived graft, Gentrix Surgical Urinary Bladder Matrix (UBM). Methods:The medical records of 65 patients who underwent paraesophageal hernia repair (PEHR) were reviewed. Primary data points included demographics, first-time or recurrent hernia, operative approach, graft or primary repair, operative time, and postoperative complications. Patients then underwent upper gastrointestinal series, completed the GERD-HRQL symptom severity questionnaire, and the SF-36 generic quality of life instrument.Results: A total of 32 patients underwent graft-reinforced repair, 33 underwent primary repair. More patients in the UBM group were being treated for recurrent PEH. Demographic data and postoperative complications were similar. There was no difference in recurrence rates, size of recurrence, postoperative symptomatic or quality of life improvement. Patients who suffered recurrence in the primary repair group had more severe symptoms and a higher rate of dissatisfaction. Of the 3 patients with recurrences after Gentrix placement, reoperation demonstrated anterior failure where no reinforcement had occurred because of the posteriorly placed U-shaped graft.Conclusions: The use of UBM was not associated with an increased complications despite use in more difficult patients. Although there appeared to be no difference in recurrence rate or size, it was associated with less severe symptomatic recurrences. The U-shape configuration is prone to recurrence at the site of the repair not covered by the graft, suggesting that a keyhole configuration may be superior.

Quality of life after giant hiatus hernia repair

“…reported a significant difference in QoL between mesh and no-mesh groups ( P <0.0001),[ 19 ] however the remaining five studies found no statistically significant difference in the two groups. [ 16 20 41 61 62 ] Two studies used mesh in all the patients;[ 31 39 ] At 2 years follow up with barium examination and endoscopy, Hazebroek et al . [ 31 ] found no mesh erosion and only one asymptomatic recurrent hernia of <2 cms.…”

Preoperatif Aneminin Hiatal Herni Cerrahisi ve Postoperatif Komplikasyonlara Etkisi

“…Therefore, the presence of ulcers and the location of the ulcers in patients is not known. Furthermore, it has been shown that as the ulcer regresses with hiatal hernia repair, anemia can also be treated, and complications that may be caused by hiatal hernia can be prevented (19,20).…”

Extracellular Matrices as Bioactive Materials for In Situ Tissue Regeneration

“…UBM reinforcement facilitated the repair of a large hiatal hernia concomitant with a sleeve gastrectomy surgery ( Figure 4 M–O) [ 128 ]. UBM-reinforced repair of paraesophageal hernia was associated with fewer recurrences of severe symptoms as compared with primary repair [ 129 ].…”