Long-term outcomes of laparoscopic large hiatus hernia repair with nonabsorbable mesh

Gordon, Andrew C.; Gillespie, Carla; Son, Ji Won; Polhill, T.; Leibman, Steven; Smith, Garett

doi:10.1093/dote/dox156

Cited by 15 publications

(9 citation statements)

References 26 publications

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“…Many studies have presented supportive short-term results comparing the use of mesh to non-mesh HH repair. However, mixed hernia recurrence rates have been reported over a longer follow-up period, calling into question the benefit of mesh repair [9][10][11][12][13][14] . CMS value-based programs have been touted as quality financial incentives to reduce readmissions and model pay-for-performance.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes in Patients Undergoing Paraesophageal Hiatal Hernia Repair

Howell

Liu

Petrone

et al. 2020

Sci Rep

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Many patients with hiatal hernias (HH) are asymptomatic; however, symptoms may include heartburn, regurgitation, dysphagia, nausea, or vague epigastric pain depending on the hernia type and severity. the ideal technique and timing of repair remains controversial. this report describes short-term outcomes and readmissions of patients undergoing HH repair at our institution. All patients who underwent HH repair from January 2012 through April 2017 were reviewed. Patients undergoing concomitant bariatric surgery were excluded. 239 patients were identified and 128 were included. Eighty-eight were female (69%) and 40 were male (31%) with a mean age of 59 years (range 20-91 years) and a mean BMI of 29.2 kg/m 2 (17-42). Worsening GERD was the most common presenting symptom in 79 (61.7%) patients. Eighty-four laparoscopic cases (65.6%) and 44 robotic assisted (34.4%) procedures were performed. Mesh was used in 59 operations (3 polytetrafluoroethylene; 56 biologic). All hiatal hernia types (I-IV) were collected. Majority were initial operations (89%). Techniques included: Toupet fundoplication in 68 cases (63.0%), Nissen fundoplication in 36 (33.3%), Dor fundoplication in 4 (3.7%), concomitant Collis gastroplasty in 4 (3.1%), and primary suture repair in 20 (15.6%). Outcomes between robotic and laparoscopic procedures were compared. Length of stay was reported as median and interquartile range for laparoscopic and robotic: 1.0 day (1.0-3.0) and 2.0 days (1.0-2.5); p = 0.483. Thirty-day readmission occurred in 9 patients, 7 (8.3%) laparoscopic and 2 (4.6%) robotic; p = 0.718. Two 30-day reoperations occurred, both laparoscopic; p = 0.545. Total of 16 complications occurred; 18.6% had a complication with the use of mesh compared to 8.7% without the use of mesh, p = 0.063. there were no conversion to open modality and no mortalities were reported. Hiatal hernia repair can be performed safely with a low incidence of complications.

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Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes in Patients Undergoing Paraesophageal Hiatal Hernia Repair

Howell

Liu

Petrone

et al. 2020

Sci Rep

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“…Long-term outcomes in strengthening the abdominal wall in hernias are good or even excellent. 24 The infection rate is very low and recurrence is rare. Hypersensitivity to implant materials occurs infrequently.…”

Section: Discussionmentioning

confidence: 99%

Polyethylene terephthalate tape augmentation as a solution in recurrent quadriceps tendon ruptures

2019

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Quadriceps tendon rupture is a severe and demanding problem in knee surgery, especially when it is recurrent and when elderly patients are involved. It can have a devastating impact when it is a complication following knee arthroplasty. There are many procedures for dealing with this problem, but none of them offer reliable results. The most popular methods of treatment are traditional transosseous sutures and suture anchors, often in combination with semitendinosus augmentation. In cases of osteoporotic bone or hamstring insufficiency, these solutions are not appropriate. One way to manage quadriceps tendon rupture is to use polyethylene terephthalate tape (poly tape) as scaffolding for tissue ingrowth. Because of its structure, poly tape provides adequate strength and allows early mobilization. Besides being durable, multifilament high tenacity polyethylene terephthalate is flexible. Poly tape augmentation is particularly recommended in the following cases: recurrent rupture of the quadriceps tendon; extensor apparatus damage following total knee arthroplasty (TKA); delayed diagnosis of quadriceps tendon rupture; and in elderly patients (with weak bones and poor ligament quality). The surgical technique is simple and the procedure has a low complication rate. There have been many studies confirming the security of polyethylene terephthalate use in the human body. There is also a great deal of evidence concerning tissue ingrowth in the mesh structure of poly tape. Allergic reactions and inflammatory responses are rare. Cite asLeciejewski M, Królikowska A, Reichert P. Polyethylene terephthalate tape augmentation as a solution in recurrent quadriceps tendon ruptures.

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“…In light of the good results achieved with the introduction of prosthetic materials in inguinal and ventral repair surgery, the use of meshes has been proposed also in PEH repair. There is a wide array of configurations, materials (including synthetic non-absorbable, absorbable, or biologic matrices), and methods of fixation of the mesh (anterior, posterior, or circumferential, with staples, tacks, sutures, or glue) [32][33][34][35][36] .…”

Section: Peh Sac Excisionmentioning

confidence: 99%

Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

Ugliono¹,

Rebecchi²,

Seno³

et al. 2021

Mini-invasive Surg

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Paraesophageal Hernia (PEH) is the protrusion of the stomach and/or other abdominal viscera into the mediastinum due to an enlargement of the diaphragmatic hiatus. The treatment of PEH is challenging: On the one hand, watchful waiting carries the risk of developing acute life-threatening complications requiring an emergency operation. On the other hand, elective repair of PEH has non-negligible morbidity and mortality rates, also due to the characteristics of PEH affected patients, who are generally elder and frail. A review of the literature is presented to highlight strategies that can be adopted to minimize early and long-term complications after PEH surgical repair. The laparoscopic approach has been shown to provide reduced hospital stay, postoperative morbidity and mortality, and overall costs compared to traditional open surgery, and it is currently considered the standard approach both to elective and emergency operations. The evidence suggests that strict adherence to surgical principles, such as hernia sac excision, extended mediastinal dissection of the esophagus, and tension-free crural repair with or without mesh are mandatory to achieve optimal surgical outcomes and reduce PEH recurrence rate. Different shapes, materials, and techniques of prosthetic repair and the use of relaxing incisions have been proposed, but long-term data are lacking, and no conclusions can be drawn regarding the ideal method of crural closure. When a short esophagus is recognized despite extensive mediastinal dissection, esophageal lengthening procedures are indicated. Systematic addition of a fundoplication is strongly encouraged, for either treating gastroesophageal reflux or reducing recurrence rate.

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Long-term outcomes of laparoscopic large hiatus hernia repair with nonabsorbable mesh

Cited by 15 publications

References 26 publications

Short-Term Outcomes in Patients Undergoing Paraesophageal Hiatal Hernia Repair

Short-Term Outcomes in Patients Undergoing Paraesophageal Hiatal Hernia Repair

Polyethylene terephthalate tape augmentation as a solution in recurrent quadriceps tendon ruptures

Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

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