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Surgical and clinical outcomes comparison of mesh usage in laparoscopic hiatal hernia repair

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Abstract

Purpose

Use of absorbable mesh in hiatal hernia (HH) repair has been shown to decrease recurrence rates. Our aim was to compare the efficiency of three meshes in relation to the surgical outcomes of patients undergoing HH repair.

Methods

A single-institution retrospective review was done for adult patients who underwent HH repair with mesh between 2004 and 2016. Demographics, intra-operative, and cost data were collected. Esophageal symptoms and medication use were assessed pre- and postoperatively. Surgical outcomes were evaluated at 6-, 12-months, and long-term follow-up. Three groups were created based on type of mesh: human tissue matrix (HTM), biosynthetic mesh (BIOS), or porcine tissue matrix (PTM). Comparisons were performed between groups using SPSS v.26.0 and PC SAS v9.4, α = 0.05.

Results

292 patients were included (HTM:N = 162, BIOS:N = 83, PTM:N = 47). Majority were male (60.4%), Caucasian (93.2%), median age, and BMI of 59 years [25–90 years] and 29.19 kg/m2 [18.9–58.0 kg/m2], respectively. 69% had a large HH. Median follow-up time was 27 months [1–166 months]. Overall recurrence rate was 39%, being significantly lower in BIOS at long-term (HTM: 31%, BIOS: 17%, PTM: 19%, p = 0.038). All groups had a significant postoperative improvement of esophageal symptoms, all p < 0.001. 65–70% of the cost difference between the groups was incurred by the cost of mesh alone (HTM: $1072, BIOS: $548, PTM: $1295), with the remainder attributable to the surgery itself.

Conclusion

While outcomes of the three mesh groups were similar in our data, there was a significant difference in mesh cost. Surgeon and hospital preference still play a role in choosing the type of mesh used; however, knowledge of the individual mesh cost will help surgeons make better informed decisions.

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References

  1. Zehetner J, Demeester SR, Ayazi S, Kilday P, Augustin F, Hagen JA, Lipham JC, Sohn HJ, Demeester TR (2011) Laparoscopic versus open repair of paraesophageal hernia: the second decade. J Am Coll Surg 212:813–820. https://doi.org/10.1016/j.jamcollsurg.2011.01.060

    Article  PubMed  Google Scholar 

  2. Lebenthal A, Waterford SD, Fisichella PM (2015) Treatment and controversies in paraesophageal hernia repair. Front Surg 2:13. https://doi.org/10.3389/fsurg.2015.00013

    Article  PubMed  PubMed Central  Google Scholar 

  3. Petersen LF, McChesney SL, Daly SC, Millikan KW, Myers JA, Luu MB (2014) Permanent mesh results in long-term symptom improvement and patient satisfaction without increasing adverse outcomes in hiatal hernia repair. Am J Surg 207:445–448. https://doi.org/10.1016/j.amjsurg.2013.09.014

    Article  PubMed  Google Scholar 

  4. Jones R, Simorov A, Lomelin D, Tadaki C, Oleynikov D (2015) Long-term outcomes of radiologic recurrence after paraesophageal hernia repair with mesh. Surg Endosc 29:425–430. https://doi.org/10.1007/s00464-014-3690-8

    Article  PubMed  Google Scholar 

  5. Targarona EM, Bendahan G, Balague C, Garriga J, Trias M (2004) Mesh in the hiatus: a controversial issue. Arch Surg 139:1286–1296

    Article  Google Scholar 

  6. Champion JK, Rock D (2003) Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 17:551–553. https://doi.org/10.1007/s00464-002-8817-7

    Article  CAS  PubMed  Google Scholar 

  7. Lazar DJ, Birkett DH, Brams DM, Ford HA, Williamson C, Nepomnayshy D (2017) Long-term patient-reported outcomes of paraesophageal hernia repair. JSLS. https://doi.org/10.4293/JSLS.2017.00052

    Article  PubMed  PubMed Central  Google Scholar 

  8. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481–490. https://doi.org/10.1097/01.sla.0000237759.42831.03

    Article  PubMed  PubMed Central  Google Scholar 

  9. Lomelin D, Smith A, Bills N, Chiruvella A, Crawford C, Krause C, Bayer R, Oleynikov D (2017) Long-term effectiveness of strattice in the laparoscopic closure of paraesophageal hernias. Surg Innov 24:259–263. https://doi.org/10.1177/1553350617693520

    Article  PubMed  Google Scholar 

  10. Rosen MJ, Borao FJ, Binenbaum SJ, Roth JS, Gillian GK, Gould J, Heniford BT (2019) A multi-center, prospective clinical trial of a hepatic derived porcine surgical mesh for the laparoscopic repair of symptomatic paraesophageal hernias. Am J Surg 218:315–322

    Article  Google Scholar 

  11. Olson MT, Singhal S, Panchanathan R, Roy SB, Kang P, Ipsen T, Mittal SK, Huang JL, Smith MA, Bremner RM (2018) Primary paraesophageal hernia repair with Gore(R) Bio-A(R) tissue reinforcement: long-term outcomes and association of BMI and recurrence. Surg Endosc. https://doi.org/10.1007/s00464-018-6200-6

    Article  PubMed  Google Scholar 

  12. Panici Tonucci T, Asti E, Sironi A, Ferrari D, Bonavina L (2020) Safety and efficacy of crura augmentation with phasix ST mesh for large hiatal hernia: 3-year single-center experience. J Laparoendosc Adv Surg Tech. https://doi.org/10.1089/lap.2019.0726

    Article  Google Scholar 

  13. Korwar V, Adjepong S, Pattar J, Sigurdsson A (2019) Biological mesh repair of paraesophageal hernia: an analysis of our outcomes. J Laparoendosc Adv Surg Tech 29:1446–1450

    Article  Google Scholar 

  14. Zhang C, Liu D, Li F, Watson DI, Gao X, Koetje JH, Luo T, Yan C, Du X, Wang Z (2017) Systematic review and meta-analysis of laparoscopic mesh versus suture repair of hiatus hernia: objective and subjective outcomes. Surg Endosc 31:4913–4922. https://doi.org/10.1007/s00464-017-5586-x

    Article  PubMed  PubMed Central  Google Scholar 

  15. Asti E, Lovece A, Bonavina L, Milito P, Sironi A, Bonitta G, Siboni S (2016) Laparoscopic management of large hiatus hernia: five-year cohort study and comparison of mesh-augmented versus standard crura repair. Surg Endosc 30:5404–5409. https://doi.org/10.1007/s00464-016-4897-7

    Article  PubMed  Google Scholar 

  16. Ringley CD, Bochkarev V, Ahmed SI, Vitamvas ML, Oleynikov D (2006) Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience. Am J Surg 192(6):767–772

    Article  Google Scholar 

  17. Antonino A, Giorgio R, Giuseppe F, de Giovanni V, Silvia DG, Daniela C, Giuseppe DB, Vincenzo S, Gaspare G (2014) Hiatal hernia repair with gore bio-a tissue reinforcement: our experience. Case Rep Surg 2014:851278. https://doi.org/10.1155/2014/851278

    Article  PubMed  PubMed Central  Google Scholar 

  18. Antiporda M, Veenstra B, Jackson C, Kandel P, Daniel Smith C, Bowers SP (2018) Laparoscopic repair of giant paraesophageal hernia: are there factors associated with anatomic recurrence? Surg Endosc 32:945–954. https://doi.org/10.1007/s00464-017-5770-z

    Article  PubMed  Google Scholar 

  19. Parker DM, Rambhajan AA, Horsley RD, Johanson K, Gabrielsen JD, Petrick AT (2017) Laparoscopic paraesophageal hernia repair is safe in elderly patients. Surg Endosc 31:1186–1191. https://doi.org/10.1007/s00464-016-5089-1

    Article  PubMed  Google Scholar 

  20. Blake AM, Mittal SK (2018) Long-term clinical outcomes after intrathoracic stomach surgery: a decade of longitudinal follow-up. Surg Endosc 32:1954–1962. https://doi.org/10.1007/s00464-017-5890-5

    Article  PubMed  Google Scholar 

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Funding

Funding for this study was provided by W. L. Gore & Associates and by the Center for Advanced Surgical Technology at the University of Nebraska Medical Center.

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Authors and Affiliations

  1. Department of Surgery, University of Nebraska Medical Center, 986245 Nebraska Medical Center, Omaha, NE, 68198-6245, USA

    Priscila R. Armijo & Crystal Krause

  2. Center for Advanced Surgical Technology, University of Nebraska Medical Center, 986246 Nebraska Medical Center, Omaha, NE, 68198-6246, USA

    Priscila R. Armijo, Crystal Krause & Dmitry Oleynikov

  3. College of Medicine, University of Nebraska Medical Center, 986246 Nebraska Medical Center, Omaha, NE, 68198-6246, USA

    Tailong Xu

  4. College of Public Health, University of Nebraska Medical Center, 984355 Nebraska Medical Center, Omaha, NE, 68198-4355, USA

    Valerie Shostrom

Authors
  1. Priscila R. Armijo
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  2. Crystal Krause
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  4. Valerie Shostrom
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  5. Dmitry Oleynikov
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Corresponding author

Correspondence to Priscila R. Armijo.

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Disclosures

Dr. Dmitry Oleynikov and Dr. Priscila Rodrigues Armijo declared conflict of interest directly related to the submitted work and received a research grant support from W.L. GORE & Associates. Mr. Tailong Xu, Dr. Crystal Krause, and Ms. Valerie Shostrom have no conflicts of interest or financial ties to disclose.

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The address for Dr. Dmitry Oleynikov reflects the address at the time the study was performed.

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Armijo, P.R., Krause, C., Xu, T. et al. Surgical and clinical outcomes comparison of mesh usage in laparoscopic hiatal hernia repair. Surg Endosc 35, 2724–2730 (2021). https://doi.org/10.1007/s00464-020-07703-4

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  • DOI: https://doi.org/10.1007/s00464-020-07703-4

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