Reinforcement of hiatal defect repair with absorbable mesh fixed with non-permanent devices

Abstract

Reinforcement with absorbable mesh-cancel bio mesh is a safe and effective option for laparoscopic HH repair in normal weight and obese patients.

Simple versus reinforced cruroplasty in patients submitted to concomitant laparoscopic sleeve gastrectomy: prospective evaluation in a bariatric center of excellence

“…In the first 25 cases, the mesh was fixed by absorbable tacks and fibrin glue together, and then, fibrin glue was used alone in the rest of the study to reduce the cost. The results were similar according to our previously published study [17].…”

“…Moreover, the ''U'' concavity was enlarged approximately 1 cm downward to reduce the risk of possible contact with the esophagus. After this, the modified bio-absorbable synthetic mesh, which was rolled like a cigarette, was inserted through the 12-mm trocar, superimposed on the cruroplasty and fixed with absorbable tacks (AbsorbaTack 5 mm Absorbable Fixation Device with 20 tacks, Covidien, Mansfield, MA, USA) and/or fibrin glue 2-4 ml, thus obtaining an on-lay mesh placement [17] (Fig. 2).…”

Gastroesophageal Reflux Disease and Sleeve Gastrectomy

“…On the other hand, polytetrafluoroethylene (PTFE) and PTFE composites induce minimal tissue reactions but are opaque and it is difficult to achieve an accurate/adequate fixation. To reduce the risk of erosion, other materials have been tested as follows: ligamentum teres, acellular dermal matrix biodegradable patch, small intestine submucosa, and synthetic bioabsorbable mesh [31,37,38]. The recent meta-analysis of Antoniou et al show that mesh-reinforced HHR in normal weight population is associated with a fourfold decreased risk for anatomic recurrence compared with simple crural closure, without advice of the best type of mesh to be used [39].…”

“…Remission of GERD symptoms was observed in 39 patients (91 %), without mesh-related complications at a mean follow-up of 17.4 months and recurrence rate of 2.3 %. The main steps of the procedure include an accurate hiatal area dissection with reduction in the abdomen of the lower esophagus for at least 5 cm, complete and anatomical vision of the hiatus with right approach (pars flaccida technique), and hiatoplasty with non-absorbable stitch reinforced with the absorbable mesh [38].…”

Residual fundus or neofundus after laparoscopic sleeve gastrectomy: is fundectomy safe and effective as revision surgery?

“…An intra-operative methylene blue test was routinely performed to check for gastric leakage, and a drain was routinely left in place for 24 h. The hiatal defect was repaired with 2 or 3 non-absorbable stitches approximating the pillars. Large defects ([4 cm 2 ) were reinforced with a synthetic absorbable mesh (BIO A tissue reinforcement, W. L. Gore & Associates, 101 Inc., Flagstaff, AZ, USA) anchored with absorbable tacks and/or fibrin glue [11]. The cruroplasty was calibrated on a 32-Fr bougie.…”