Biologic Prosthesis Reduces Recurrence After Laparoscopic Paraesophageal Hernia Repair

Oelschlager, Brant K.; Pellegrini, Carlos A.; Hunter, John G.; Soper, Nathaniel J.; Brunt, Michael; Sheppard, Brett C.; Jobe, Blair A.; Polissar, Nayak L.; Mitsumori, Lee M.; Nelson, James; Swanström, Lee L.

doi:10.1097/01.sla.0000237759.42831.03

Cited by 275 publications

(301 citation statements)

References 32 publications

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“…8,9 Reported recurrence rates have been variable and depend on the definition used 5,6 with some series excluding recurrence less than 2cm. 5,7,10 QoL has been shown to be improved following repair. 10 This improvement is not only in gastrointestinal symptoms but also impacts on general wellbeing and cardiorespiratory symptoms.…”

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confidence: 99%

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Durability of giant hiatus hernia repair in 455 patients over 20 years

Page

Furtado

Hayward

et al. 2015

annals

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INTRODUCTION The surgical management of symptomatic giant hiatus hernia (GHH) aims to improve quality of life (QoL) and reduce the risk of life threatening complications. Previous reports are predominantly those with small sample sizes and short follow-up periods. The present study sought to assess a large cohort of patients for recurrence and QoL over a longer time period. METHODS This was a follow-up study of a prospectively collected database of 455 consecutive patients. Primary repair of GHH was evaluated by endoscopy/barium meal for recurrence and a standardised symptom questionnaire for QoL. Recurrence was assessed for size, elapsed time, oesophagitis and symptoms. RESULTS Objective and subjective review was achieved in 91.9% and 68.6% of patients. The median age was 69 years (range: 15-93 years) and 64% were female. Laparoscopic repair was completed in 95% (mesh in 6% and Collis gastroplasty in 7%). The 30-day mortality rate was 0.9%. The proportion of patients alive at five and ten years were 90% and 75% respectively. Postoperative QoL scores improved from a mean of 95 to 111 (p<0.01) and were stable over time (112 at 10 years).The overall recurrence rate was 35.6% (149/418) at 42 months; this was 11.5% (48/418) for hernias >2cm and 24.2% (101/418) for <2cm. The rate of new recurrence at 0-1 years was 13.7% (>2cm = 3.4%, <2cm = 10.3%), at 1-5 years it was 30.8% (>2cm = 9.5%, <2cm = 21.3%), at 5-10 years it was 40.1% (>2cm = 13.8%, <2cm = 26.3%) and at over 10 years it was 50.0% (>2cm = 25.0%, <2cm = 25.0%). Recurrence was associated with oesophagitis but not decreased QoL. Revision surgery was required in 4.8% of cases (14.8% with recurrence). There were no interval major GHH complications. CONCLUSIONS Surgery has provided sustained QoL improvements irrespective of recurrence. Recurrence occurred progressively over ten years and may predispose to oesophagitis.

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confidence: 99%

“…5,6 As a result, numerous techniques have evolved with the aim of reducing recurrence rates. These techniques have included mesh hiatal repair 7 and Collis gastroplasty. 8,9 Reported recurrence rates have been variable and depend on the definition used 5,6 with some series excluding recurrence less than 2cm.…”

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confidence: 99%

Durability of giant hiatus hernia repair in 455 patients over 20 years

Page

Furtado

Hayward

et al. 2015

annals

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“…Prosthesis made of biological materials have appeared to be useful in a short period, but long term follow-up results have failed to demonstrate a difference in relation to simple suture in large hernias 15,16 . It was not found, in the reviewed literature, neither this kind of mesh design, nor the tactics of covering it with adipose tissue.…”

Section: Frantzides and Carlsonmentioning

confidence: 99%

“…One topic, however, has gained increasing focus: the use of prosthetic reinforcement of the crural repair 1,3,4,7,8,9,15,20 . Several types of series, prospective non-randomized studies and prospective randomized studies were published or are underway, trying to answer: 1) does it decrease recurrence?…”

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confidence: 99%

Tela de polipropileno no reparo laparoscópico de grandes hérnias hiatais: aspectos técnicos

Brandalise¹,

Aranha²,

Brandalise³

2012

ABCD, arq. bras. cir. dig.

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-Background -The minimally invasive surgery has gained rapidly important role in the treatment of gastroesophageal reflux disease. However, the best method to treat large paraesophageal hernias (type III and IV) is still under discussion. The use of prosthetics for enhancing the crural repair has been proposed by several authors in order to reduce the high relapse rates found in these patients. Aim -To demonstrate the technique and surgical results in using an idealized polypropylene mesh for the strengthening of the cruroraphy in large hiatal hernias. Methods -Was applied the polypropylene mesh to reinforce the hiatal closure in large hernias -types II to IV in Hill's classification -with a primary or recurrent hiatal defect greater than 5 cm, in a series of 70 patients. The prosthesis was done cutting a polypropylene mesh in a U-shape, adapted to the dimensions found in the intraoperative field and coating the inner edge (which will have direct contact with the esophagus) with a silicon catheter. This was achieved by removing a small longitudinal segment of the catheter and then inserting the edge of the cut mesh, fixing with running nylon 5-0 suture. Results -From 1999 to 2012, this technique was used in 70 patients. There were 52 females and 18 males, aged 32-83 years (mean 63 years). In 48 (68.6%) patients, paraesophageal hernia was primary and in 22 (31.4%), it was relapse after antireflux surgery. The only case of death in this series (1.4%) occurred on 22nd postoperative day in one patient (74 y) that had a laceration of the sutures on the fundoplication, causing gastropleural fistula and death. There was no relationship with the use of the prosthesis.A follow-up of six months or more was achieved in 60 patients (85.7%), ranging from six to 146 months (mean 49 months). All patients have at least one follow-up endoscopy or esophageal contrast examination, and a clinical interview. In this follow-up period, no cases of complications related to the prosthesis (stenosis or erosion) were observed. Conclusion-The use of this model of polypropylene mesh is safe if the technical aspects of its placement are followed carefully. ABCDDV/874RESUMO -Racional: A cirurgia minimamente invasiva ganhou rapidamente papel fundamental no tratamento da doença do refluxo gastroesofágico. Entretanto, o melhor método para as grandes hérnias paraesofágicas (tipos III e IV) ainda está em discussão. O uso de próteses para reforço da hiatoplastia tem sido proposto por diversos autores, no intuito de diminuir as altas taxas de recidivas encontradas nesses pacientes. Riscos de estenose e erosão da prótese são as complicações mais preocupantes quando se pensa em aplicar uma prótese no hiato esofágico. Objetivo -Demonstrar a técnica cirúrgica e resultados do uso de um modelo de tela idealizado no serviço dos autores para reforçar a hiatoplastia em grandes hérnias de hiato. Métodos -Uma prótese de polipropileno foi aplicada para reforço da hiatoplastia em pacientes com grandes hérnias de hiato (Tipos II a IV de Hill). A prótese ...

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“…Her ne kadar prostetik yamalar ile ilgili erozyon, migrasyon, uzun dönem disfaji gibi komplikasyonlar bildirilmiş olsa da, biyomateryallerin gelişmesi bu riski aza indirmiştir. Oelschlager'in prospektif, randomize çalışmasında, krus kapatılma tekniğine kör bir radyolog tarafından değerlendirilen post operatif 6. ay baryum floroskopilerde nüks oranı kaydedilmiş, biyolojik prostetik yama ile krus onarımı yapılan hastalarda primer onarım olan hastalara göre daha az nüks izlenmiş, perioperatif komplikasyonlar açısından iki grup arasında bir fark görülmemiş, biyoprostetik yamaya atfedilen komplikasyona rastlanmamıştır (16). Bununla beraber bazı gruplar da mesh kullanımını rutin uygulamadan ziyade, peroperatif veya radyolojik değerlendirmeye göre hasta bazlı değerlendirmeyi savunmaktadır (17).…”

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Hiatal Hernias

Bilgi¹,

Batırel²

2014

Toraks Cer Bult

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Hiatal hernias are very common and result in gastroesophageal reflux when they become symptomatic. Sliding type hiatal hernias are frequently observed; however, paraesophageal or giant hernias characterized by herniation of the fundus or whole stomach inside the chest are seen in only 1-5% of all patients. In those patients, ulcers, bleeding and obstructions can be seen. Resistance to medical treatment of gastroesophageal reflux or very large esophageal hiatus is an indication for surgical repair in hiatal hernias. Symptomatic paraesophageal hernias should be operated on as well. In the treatment of both conditions, laparoscopic fundoplication and hernia reduction are applied. Key words: Hiatal hernia, sliding hernia, paraesophageal hernia, gastroesophageal reflux ÖzetHiatal herni, toplumda çok sık görülen ve semptomatik olduğunda gastroözofajiyal reflüye neden olan bir patolojidir. Sıklıkla kayıcı tipte herniler görülürken, %1-5 hastada mide fundusu veya midenin tamamının toraksa girmesi ile oluşan paraözofajiyal ve dev herniler görülebilir. Bu hastalarda mide ülserleri, kanamalar ve obstrüksiyonlar görülebilir. Hiatal hernilerde ameliyat endikasyonları hastalığın ilaca dirençli olması veya özofajiyal hiatustaki aşırı genişliktir. Paraözofajiyal hernilerde semptomatik hastalar ameliyat edilmelidir. Her iki hastalığın tedavisinde laparoskopik fundoplikasyon ve herni ameliyatları uygulanmaktadır.Anahtar kelimeler: Hiatal herni, kayıcı herni, paraözofageal herni, gastroözofageal reflü GENEL TANIMHiatal herni, gastroözefageal bileşke ve diyafragmatik hiatusun normal anatomik ilişkisinin bozulması ile ortaya çıkar. Gastroözefageal bileşkenin pozisyonuna, herni büyüklüğüne ve içeriğine göre hiatal herniler 4 tipe ayrılırlar. KAYICI TİP (TİP I) HİATAL HERNİLERKayıcı tip (Tip I) hiatal hernide gastroözefageal bileşike, proksimal kardia ile birlikte intratorasik olarak, posterior mediastinumda izlenir. İntra abdominal basıncın artması ve özefagusun motilite bozuklukları, faringoözefgeal membranın difüz olarak gevşemesine ve kayıcı tipte hiatal herni oluşmasına sebep olabilir. Kayıcı tipte hernide endoabdominal fasya intakttır ve gerçek anlamda bir herni kesesi gözlenmez ancak özefagus fonksiyonel olarak kısalmıştır. Semptomatoloji ve Reflü ile İlişkisiTip I hiatal herni gastroözefagel reflüye karşı olan doğal bariyeri pek çok açıdan etkiler. Öncelikle Z çizgisinin intratorasik olarak yer değiştirmesi ile diyafragmatik krusların alt özefagus sfinkterine olan desteği kaybolur. Proksimal kardianın da yukarı çekilmesi His açısının da düzleşmesine sebep olacağı için reflü fiziksel olarak daha mümkün hale gelir.Hiatal herni varlığı özefagusun asit maruziyeti açısından bağımsız bir risk faktörü olarak gösterilmiş (1) olsa da, gastroözefageal reflü (GER) hastalığının semptomatolojisinin oldukça heterojen olması, herninin hangi durumlarda ana sebep olduğunu anlamayı güçleştirir. Örneğin tipik GER semptomları ile gelen hastaların %30 unda herhangi bir objektif (endoskopi, manometre veya pH monitorizasyonu) bulgu izlenmeme...

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Biologic Prosthesis Reduces Recurrence After Laparoscopic Paraesophageal Hernia Repair

Abstract: Adding a biologic prosthesis during LPEHR reduces the likelihood of recurrence at 6 months, without mesh-related complications or side effects.

Cited by 275 publications

References 32 publications

Durability of giant hiatus hernia repair in 455 patients over 20 years

Durability of giant hiatus hernia repair in 455 patients over 20 years

Tela de polipropileno no reparo laparoscópico de grandes hérnias hiatais: aspectos técnicos

Hiatal Hernias

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