Comparison of the Effectiveness of «Оnlay» Plastics of Large and Giant Hernias of the Esophageal Aperture of the Diaphragm with a Polypropylene Mesh Implant and a Biocarbon Double - Layer Mesh Implant

Abstract

This article is a continuation of a series of studies on the optimization of techniques and methods of surgical operations for hernias of the esophageal aperture of the diaphragm and is based on the use of the author's development of a model of a two-layer biocarbon mesh implant. The purpose of this study is to highlight the immediate and long-term results of using a double-layer biocarbon mesh implant in comparison with the standard method of using a polypropylene implant when operating patients with large and giant hiatal hernia.All patients were divided into 2 research groups that underwent alloplastic with various implants: Group I of 221 patients who underwent alloplasty with a polypropylene mesh implant (171 patients with large hernias of 10-20 cm2) and 50 patients with giant hernias of the esophageal orifice with the area of the hernial defect is more than 20 cm 2 ); Group II of 79 patients who underwent an original alloplastic with a bi-layer biocarbon mesh implant (50 patients with large hernias and 29 patients with giant hernia of the esophageal orifice). Postoperative complications were classified according to the Clavien-Dindo scale.The index «De Meester» was used as a comparison criterion. The article discusses the results of operations of 300 patients for large and giant hernias of the esophageal aperture of the diaphragm, of which 79 were operated on using a prototype biocarbon double-layer mesh implant according to the author's patent. The paper presents immediate and long-term results. The results of surgical treatment are pilot and representative, which determine the further tactics and direction of improving operations to remove large and giant hernias of the esophageal opening of the diaphragm. For the first time, data on the use of the author's development of a bi-layer biocarbon mesh implant are presented and compared with a polypropylene mesh implant during an «on-line» plastic repair of large and giant hiatal hernia. Significant differences were obtained in relapses of all types in favor of a biocarbon mesh implant (5,6 versus 22,8%; p < 0,0001; Fisher's exact test).