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Primary paraesophageal hernia repair with Gore® Bio-A® tissue reinforcement: long-term outcomes and association of BMI and recurrence

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Abstract

Background

Laparoscopic repair remains the gold-standard treatment for paraesophageal hernia (PEH). We analyzed long-term symptomatic outcomes and surgical reintervention rates after primary PEH repair with onlay synthetic bioabsorbable mesh (W. L. Gore & Associates, Inc., Flagstaff, AZ) and examined body mass index (BMI) as a possible risk factor for poor outcomes and for recurrence.

Methods

We queried a prospectively maintained database to identify patients who underwent laparoscopic primary PEH repair with onlay patch of a bioprosthetic absorbable mesh (Bio-A® Gore®) between 05/28/2009 and 12/31/2013. Electronic health records were accessed to record demographic and operative data and were reviewed up to the present to identify any repeat procedures. Patients were grouped according to preoperative BMI (A: BMI < 25; B: BMI = 25–29.9; C: BMI = 30–34.9; D: BMI ≥ 35). Patients completed standardized satisfaction and symptom surveys.

Results

In total, 399 patients were included. Most patients (n = 261; 65.4%) were women. Mean age was 59.6 ± 13.4 years; mean BMI was 29.9 ± 5.0 kg/m2. The patients were grouped as follows: A, 53 patients (13.3%); B, 166 (41.6%); C, 115 (28.8%); D: 65 (16.3%). Four procedures (1.0%) were converted from laparoscopy to open procedures. All patients underwent an antireflux procedure (225 Nissen, 170 Toupet, 4 Dor). A mean follow-up of 44.7 ± 22.8 months was available for 305 patients (76.4%). 24/305 patients (7.9%) underwent reoperation, and the number of reoperations did not differ among groups (P = 0.64). Long-term symptomatic outcomes were available for 217/305 patients (71.1%) at a mean follow-up of 54.0 ± 13.1  months; no significant difference was observed among groups. 194/217 patients (89.4%) reported good to excellent satisfaction, with no significant differences among the groups.

Conclusions

Laparoscopic primary PEH repair with onlay Bio-A® mesh is a safe and feasible procedure with excellent long-term patient-centered outcomes and acceptable symptomatic recurrence rate. BMI does not appear to be related to the need for surgical reintervention.

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Abbreviations

ARS:

Antireflux surgery

BMI:

Body mass index

GERD:

Gastroesophageal reflux disease

HH:

Hiatal hernia

IQR:

Interquartile range

PEH:

Paraesophageal hernia

PPI:

Proton pump inhibitor

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Acknowledgements

We would like to thank Clare Sonntag for her editorial expertise and Marco Marchionni for the illustrations that complement this study.

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Authors and Affiliations

  1. Grand Canyon University College of Science, Engineering, and Technology, Phoenix, AZ, USA

    Michael T. Olson

  2. Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, 500 W. Thomas Road, Ste. 500, Phoenix, AZ, 85013, USA

    Michael T. Olson, Saurabh Singhal, Roshan Panchanathan, Sreeja Biswas Roy, Taylor Ipsen, Sumeet K. Mittal, Jasmine L. Huang, Michael A. Smith & Ross M. Bremner

  3. University of Arizona College of Medicine, Phoenix, AZ, USA

    Roshan Panchanathan

  4. University of Arizona College of Public Health, Phoenix, AZ, USA

    Paul Kang

  5. Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA

    Taylor Ipsen

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  1. Michael T. Olson
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Correspondence to Ross M. Bremner.

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Michael T. Olson, Saurabh Singhal, Roshan Panchanathan, Sreeja Biswas Roy, Paul Kang, Taylor Ipsen, Sumeet K. Mittal, Jasmine L. Huang, Michael A. Smith and Ross M. Bremner have no conflicts of interest or financial ties to disclose.

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Olson, M.T., Singhal, S., Panchanathan, R. et al. Primary paraesophageal hernia repair with Gore® Bio-A® tissue reinforcement: long-term outcomes and association of BMI and recurrence. Surg Endosc 32, 4506–4516 (2018). https://doi.org/10.1007/s00464-018-6200-6

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