Medium-term safety and efficacy profile of paraesophageal hernia repair with Phasix-ST® mesh: a single-institution experience

Aiolfi, Alberto; Cavalli, Marta; Sozzi, Andrea; Lombardo, Francesca; Lanzaro, Alessio; Panizzo, Valerio; Bonitta, Gianluca; Mendogni, Paolo; Bruni, Piero Giovanni; Campanelli, G.; Bona, Davide

doi:10.1007/s10029-021-02528-z

Cited by 17 publications

(3 citation statements)

References 56 publications

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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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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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“…Furthermore, conduit size discrepancy can lead to postoperative medium-and long-term concerns (gradual dilation if too wide/dysphagia if too narrow), and the ectopic gastric mucosa can continue to produce acid with chronic intra-esophageal acid secretion and esophagitis [31,32] . A 2013 study by Mor et al compared the acid clearance time between Nissen fundoplication and Nissen-Collis gastroplasty [33] . They found a higher esophageal acid clearance time and pathologic esophageal acid exposure in the Nissen-Collis group compared to the Nissen fundoplication one.…”

Section: Minimally Invasive Techniques and Resultsmentioning

confidence: 99%

Tension at the hiatus: the role of lengthening procedures and relaxing incisions in paraesophageal hernias

Aiolfi¹,

Bona²,

Sozzi³

2022

Mini-invasive Surg

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Avoiding tension during hernia repair is the goal of every surgeon. In the setting of laparoscopic paraesophageal hernia (PEH) repair, tension along esophageal length (axial) and between the crura (radial) should be considered. The aim of this narrative review is to summarize the current knowledge on techniques for axial and radial tension assessment and possible minimization during laparoscopic PEH repair.

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“…In this context, the significance of synthetic long-term absorbable materials remains unclear. Recent retrospective cohort studies have shown promising results, but long-term follow-up is currently not available [18][19][20]. Augmentation of the lower esophageal sphincter is a frequently performed adjunct to pHH repair and was formally "recommended" by our participants.…”

Section: Discussionmentioning

confidence: 99%

Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

Gerdes

Schoppmann²,

Bonavina³

et al. 2023

Surg Endosc

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Aims There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as “recommended” or “discouraged” if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled “acceptable” (neither recommended nor discouraged). Results Seventy-two surgeons with a median (IQR) experience of 23 (14–30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15–36) and 40 (28–60) pHH-surgeries, respectively. After Delphi round 2, “recommended” strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified “discouraged” strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were “acceptable”. Conclusions This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.

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Medium-term safety and efficacy profile of paraesophageal hernia repair with Phasix-ST® mesh: a single-institution experience

Cited by 17 publications

References 56 publications

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

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

Tension at the hiatus: the role of lengthening procedures and relaxing incisions in paraesophageal hernias

Management of paraesophageal hiatus hernia: recommendations following a European expert Delphi consensus

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