Abstract
Background
Laparoscopic repair of a large hiatal hernia using simple sutures only for the cruroplasty is associated with a high recurrence rate. The solution was to place synthetic mesh over the cruroplasty thereby decreasing recurrence rates in exchange for complications, such as gastric and esophageal erosions. Our initial report investigated the use of human acellular dermal matrix (AlloDerm) as a more suitable alternative. This study highlights our long-term results > 1 year of cruroplasty reinforcement with AlloDerm in the repair of large hiatal hernias.
Methods and Material
This is a retrospective study performed at our university. Between 2005 and 2006, 52 consecutive patients with large hiatal hernias had the cruroplasty site reinforced with AlloDerm. The variables analyzed were age, sex, weight, height, hiatal hernia size, operative time, length of hospital stay, follow-up, and postoperative complications.
Results
The mean for age was 56.7 years, for weight was 87.9 kg, for height 117 cm, for hernia size was 5.75 cm, operative time was 121 min, and for hospital stay was 1.36 days. Complication included pneumothorax, 3 (5.5%); atelectasis, 1 (1.9%); urinary retention, 1 (1.9%); and recurrence, 2 (3.8%).
Conclusion
Laparoscopic hiatal hernia repair with reinforcement using human acellular dermal matrix can be performed safely with a short hospital stay and low rate of complications, especially a low rate of recurrence.
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References
Hashemi M, Peters JH, DeMeester TR et al. Laparoscopic repair of large type III hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg 2000;190:554–561.
Khaitan L, Houston H, Sharp K, Holzman M, Richards W. Laparoscopic paraesophageal hernia repair has an acceptable recurrence rate. Am Surgeon 2002;68(6):546–551. discussion 551–552, Jun.
Stirling M, Orringer M. Surgical treatment after failed antireflux operations. J Thorac Cardiovasc Surg 1986;92:667–672.
Frantzides CT, Madar AK, Carlson MA, Stavropoulos GP. A prospective, randomized trial of laparoscopic polypropylene patch vs. simple cruroplasty for large hiatal hernia. Arch Surg 2002;137:649–652.
Granderath FA, Schweiger UM, Kamolz T et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 2005;140:40–48.
Paul MG, DeRosa RP, Petrucci PE et al. Laparoscopic tension-free repair of large paraesophageal hernias. Surg Endosc 1997;11:303–307.
Trus TL, Bax T, Richardson WS et al. Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1997;1:221–228.
Casabella F, Sinanan M, Horgan S. Symptomatic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 1996;171:485–489.
Edelman DS. Laparoscopic paraesophageal hernia repair with mesh. Surg Laparosc Endosc 1995;5:32–37.
Dutta S. Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery. J Pediatr Surg 2007;42:252–256.
Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 2006;244(4):481–90. October.
Ringley CD, Bochkarev V, Ahmed SI, Vitamvas ML, Oleynikov D. Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience. Am J Surg 2006;192(6):767–772. Dec.
Matter SG, Bowers SP, Galloway KP et al. Long-term outcomes of laparoscopic repair of paraesophageal hernia. Surg Endosc 2002;16:745–49.
Stirling M, Orringer M. Surgical treatment after failed antireflux operations. J Thorac Cardiovasc Surg 1986;92:667–672.
Klaristenfeld DD, Mahoney E, Ianitti DA. Minimally invasive tension free inguinal hernia repair. Surg Technol Int 2005;14:157–163.
Reyes-Devesa HE, Martinez-Dejesus F, Martinez-Mier G, Vinas-Dozal JC. A new open anterior tension-free onlay patch technique for inguinofemoral hernia repair. Am J Surg 2005;190(1):118–22. Jul.
Machairas A, Misiakos EP, Liakakos T, Karatzas G. Incisional hernioplasty with extraperitoneal onlay polyester mesh. Am Surg 2004;70(8):726–729. Aug.
Aura T, Habib E, Mekkaoui M, Brassier D, Elhadad A. Laparascopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperiotneal Gore-Tex mesh: prospective study and review of the literature. J Laparoendosc Adv Surg Tech Part A 2002;12(4):263–267. Aug.
Wisbach G, Peterson T, Thoman D. Early results of the use of acellular dermal allograft in type III paraesophageal hernia repair. JSLS 2006;10(2):184–187. April–June.
Carlson MA, Condon RE, Ludwig KA, Schulte WJ. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 1998;187(3):227–230. Sep.
Schneider R, Herrington JL Jr, Granda AM. Marlex mesh in repair of a diaphragmatic defect later eroding into the distal esophagus and stomach. Am Surg 1979;45(5):337–339. May.
Butler CE, Prieto VG. Reduction of adhesions with composite AlloDerm/polypropylene mesh implants for abdominal wall reconstruction. Plast Reconstr Surg 2004;114(2):464–473. August.
Acknowledgments
We would like to acknowledge Rhonda Prewitt, MIS Program Administrator, and the grant support provided by AlloDerm.
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Lee, Y.K., James, E., Bochkarev, V. et al. Long-term Outcome of Cruroplasty Reinforcement with Human Acellular Dermal Matrix in Large Paraesophageal Hiatal Hernia. J Gastrointest Surg 12, 811–815 (2008). https://doi.org/10.1007/s11605-007-0463-x
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DOI: https://doi.org/10.1007/s11605-007-0463-x