Skip to main content

Advertisement

SpringerLink
Log in

A simplified technique for intrathoracic stomach repair: laparoscopic fundoplication with Vicryl mesh and BioGlue crural reinforcement

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Laparoscopic repair of an intrathoracic stomach has been associated with a high recurrence rate. The use of biologic or synthetic mesh to reinforce the crural repair has been shown to reduce recurrence. This study aimed to assess a simplified technique for reinforcing the crural repair using absorbable Vicryl mesh secured with BioGlue during laparoscopic repair of an intrathoracic stomach.

Methods

The charts of all patients who underwent laparoscopic repair of an intrathoracic stomach from June 2006 to March 2009 using the described technique were retrospectively reviewed. Intrathoracic stomach was defined as more than 50% of the stomach herniated into the chest. Follow-up assessment was routinely performed 1 year or more after surgery and included endoscopy, video esophagram, Bravo 48-h pH monitoring, and a gastroesophageal reflux disease (GERD)–health-related quality-of-life (HRQL) questionnaire.

Results

A total of 35 patients (male:female = 10:25) with a mean age of 70 years (48–89 years) and a mean body mass index (BMI) of 30.4 kg/m2 (20.4–44.8 kg/m2) underwent repair using this technique. The median operating time was 144 min (101–311 min), and the median hospital stay was 2 days (1–21 days). There were three conversions (8.6%) and one intraoperative complication (2.9%). Three patients (8.6%) experienced postoperative complications. No mesh-related complications occurred. Follow-up assessment 1 year or more after surgery was available for 21 of the 25 eligible patients [median follow-up period, 14 months (11–34 months)]. There were two recurrences (9.5%), one of them asymptomatic. The median GERD-HRQL score was 5 (2–28). Nearly all the patients (91.3%) were satisfied with the operation, and 96% would have it again.

Conclusion

Vicryl mesh secured with BioGlue is a simple and easy method for reinforcing the crural closure during laparoscopic repair of an intrathoracic stomach. The recurrence rate at 1 year is low and comparable with that of other series using biologic mesh secured with sutures or tacks.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236:492–500; discussion 500–501

    Article  PubMed  Google Scholar 

  2. Ozdemir IA, Burke WA, Ikins PM (1973) Paraesophageal hernia: a life-threatening disease. Ann Thorac Surg 16:547–554

    Article  PubMed  CAS  Google Scholar 

  3. Edye MB, Canin-Endres J, Gattorno F, Salky BA (1998) Durability of laparoscopic repair of paraesophageal hernia. Ann Surg 228:528–535

    Article  PubMed  CAS  Google Scholar 

  4. Huntington TR (1997) Short-term outcome of laparoscopic paraesophageal hernia repair: a case series of 58 consecutive patients. Surg Endosc 11:894–898

    Article  PubMed  CAS  Google Scholar 

  5. Koger KE, Stone JM (1993) Laparoscopic reduction of acute gastric volvulus. Am Surg 59:325–328

    PubMed  CAS  Google Scholar 

  6. Oddsdottir M, Franco AL, Laycock WS, Waring JP, Hunter JG (1995) Laparoscopic repair of paraesophageal hernia: new access, old technique. Surg Endosc 9:164–168

    Article  PubMed  CAS  Google Scholar 

  7. Perdikis G, Hinder RA, Filipi CJ, Walenz T, McBride PJ, Smith SL, Katada N, Klingler PJ (1997) Laparoscopic paraesophageal hernia repair. Arch Surg 132:586–589; discussion 590–581

    PubMed  CAS  Google Scholar 

  8. Pitcher DE, Curet MJ, Martin DT, Vogt DM, Mason J, Zucker KA (1995) Successful laparoscopic repair of paraesophageal hernia. Arch Surg 130:590–596

    PubMed  CAS  Google Scholar 

  9. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF et al (2000) Laparoscopic repair of large type III hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg 190:553–560; discussion 560–551

    Article  PubMed  CAS  Google Scholar 

  10. Granderath FA, Carlson MA, Champion JK, Szold A, Basso N, Pointner R, Frantzides CT (2006) Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc 20:367–379

    Article  PubMed  CAS  Google Scholar 

  11. Hazebroek EJ, Koak Y, Berry H, Leibman S, Smith GS (2009) Critical evaluation of a novel DualMesh repair for large hiatal hernias. Surg Endosc 23:193–196

    Article  PubMed  CAS  Google Scholar 

  12. Hazebroek EJ, Ng A, Yong DH, Berry H, Leibman S, Smith GS (2008) Evaluation of lightweight titanium-coated polypropylene mesh (TiMesh) for laparoscopic repair of large hiatal hernias. Surg Endosc 22:2428–2432

    Article  PubMed  Google Scholar 

  13. Granderath FA, Granderath UM, Pointner R (2008) Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg 32:999–1007

    Article  PubMed  CAS  Google Scholar 

  14. Muller-Stich BP, Holzinger F, Kapp T, Klaiber C (2006) Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement. Surg Endosc 20:380–384

    Article  PubMed  CAS  Google Scholar 

  15. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J et al (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481–490

    PubMed  Google Scholar 

  16. Kemppainen E, Kiviluoto T (2000) Fatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia. Surg Endosc 14:593

    PubMed  CAS  Google Scholar 

  17. Muller-Stich BP, Linke G, Leemann B, Lange J, Zerz A (2006) Cardiac tamponade as a life-threatening complication in antireflux surgery. Am J Surg 191:139–141

    Article  PubMed  Google Scholar 

  18. Ayazi S, Lipham JC, Portale G, Peyre CG, Streets CG, Leers JM, Demeester SR, Banki F, Chan LS, Hagen JA et al (2009) Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy. Clin Gastroenterol Hepatol 7:60–67

    Article  PubMed  Google Scholar 

  19. Velanovich V (2007) The development of the GERD-HRQL symptom severity instrument. Dis Esophagus 20:130–134

    Article  PubMed  CAS  Google Scholar 

  20. Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA (1996) Quality-of-life scale for gastroesophageal reflux disease. J Am Coll Surg 183:217–224

    PubMed  CAS  Google Scholar 

  21. Tatum RP, Shalhub S, Oelschlager BK, Pellegrini CA (2008) Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg 12:953–957

    Article  PubMed  Google Scholar 

  22. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ (2008) Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23:1219–1226

    Article  PubMed  Google Scholar 

  23. Diwan TS, Ujiki MB, Dunst CM, Swanstrom LL (2008) Biomesh placement in laparoscopic repair of paraesophageal hernias. Surg Innov 15:184–187

    Article  PubMed  CAS  Google Scholar 

  24. Jacobs M, Gomez E, Plasencia G, Lopez-Penalver C, Lujan H, Velarde D, Jessee T (2007) Use of surgisis mesh in laparoscopic repair of hiatal hernias. Surg Laparosc Endosc Percutan Tech 17:365–368

    Article  PubMed  Google Scholar 

  25. Johnson JM, Carmody BJ, Jamal MK, DeMaria EJ (2005) Onlay hiatal reinforcement utilizing human acellular dermal matrix: three case series. Surg Innov 12:239–241

    Article  PubMed  Google Scholar 

  26. Delany HM, Porreca F, Mitsudo S, Solanki B, Rudavsky A (1982) Splenic capping: an experimental study of a new technique for splenorrhaphy using woven polyglycolic acid mesh. Ann Surg 196:187–193

    Article  PubMed  CAS  Google Scholar 

  27. Delany HM, Rudavsky AZ, Lan S (1985) Preliminary clinical experience with the use of absorbable mesh splenorrhaphy. J Trauma 25:909–913

    Article  PubMed  CAS  Google Scholar 

  28. Maurer PK, McDonald JV (1985) Vicryl (polyglactin 910) mesh as a dural substitute. J Neurosurg 63:448–452

    Article  PubMed  CAS  Google Scholar 

  29. Mori N, Takano K, Miyake T, Nishio T, Muto S, Koshizuka K, Nakagomi H, Kubo M, Tada Y (1998) A comparison of prosthetic materials used to repair abdominal wall defects. Pediatr Surg Int 13:487–490

    Article  PubMed  CAS  Google Scholar 

  30. Marmon LM, Vinocur CD, Standiford SB, Wagner CW, Dunn JM, Weintraub WH (1985) Evaluation of absorbable polyglycolic acid mesh as a wound support. J Pediatr Surg 20:737–742

    Article  PubMed  CAS  Google Scholar 

  31. Alamanni F, Fumero A, Parolari A, Trabattoni P, Cannata A, Berti G, Biglioli P (2001) Sutureless double-patch-and-glue technique for repair of subacute left ventricular wall rupture after myocardial infarction. J Thorac Cardiovasc Surg 122:836–837

    Article  PubMed  CAS  Google Scholar 

  32. Herget GW, Kassa M, Riede UN, Lu Y, Brethner L, Hasse J (2001) Experimental use of an albumin-glutaraldehyde tissue adhesive for sealing pulmonary parenchyma and bronchial anastomoses. Eur J Cardiothorac Surg 19:4–9

    Article  PubMed  CAS  Google Scholar 

  33. Hewitt CW, Marra SW, Kann BR, Tran HS, Puc MM, Chrzanowski FA Jr, Tran JL, Lenz SD, Cilley JH Jr, Simonetti VA et al (2001) BioGlue surgical adhesive for thoracic aortic repair during coagulopathy: efficacy and histopathology. Ann Thorac Surg 71:1609–1612

    Article  PubMed  CAS  Google Scholar 

  34. Nadler RB, Loeb S, Rubenstein RA, Vardi IY (2006) Use of BioGlue in laparoscopic partial nephrectomy. Urology 68:416–418

    Article  PubMed  Google Scholar 

  35. Passage J, Tam R, Windsor M, O’Brien M (2005) Bioglue: a review of the use of this new surgical adhesive in thoracic surgery. ANZ J Surg 75:315–318

    Article  PubMed  Google Scholar 

  36. Raanani E, Latter DA, Errett LE, Bonneau DB, Leclerc Y, Salasidis GC (2001) Use of “BioGlue” in aortic surgical repair. Ann Thorac Surg 72:638–640

    Article  PubMed  CAS  Google Scholar 

  37. Tansley P, Al-Mulhim F, Lim E, Ladas G, Goldstraw P (2006) A prospective, randomized, controlled trial of the effectiveness of BioGlue in treating alveolar air leaks. J Thorac Cardiovasc Surg 132:105–112

    Article  PubMed  Google Scholar 

  38. Ellis FH Jr, Crozier RE, Shea JA (1986) Paraesophageal hiatus hernia. Arch Surg 121:416–420

    PubMed  Google Scholar 

  39. Pearson FG, Cooper JD, Ilves R, Todd TR, Jamieson WR (1983) Massive hiatal hernia with incarceration: a report of 53 cases. Ann Thorac Surg 35:45–51

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033, USA

    Jörg Zehetner, John C. Lipham, Shahin Ayazi, Arzu Oezcelik, Emmanuele Abate, Weisheng Chen, Steven R. DeMeester, Helen J. Sohn, Farzaneh Banki, Jeffrey A. Hagen, Melissa Dickey & Tom R. DeMeester

Authors
  1. Jörg Zehetner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John C. Lipham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shahin Ayazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arzu Oezcelik
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emmanuele Abate
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Weisheng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven R. DeMeester
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Helen J. Sohn
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Farzaneh Banki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jeffrey A. Hagen
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Melissa Dickey
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tom R. DeMeester
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John C. Lipham.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zehetner, J., Lipham, J.C., Ayazi, S. et al. A simplified technique for intrathoracic stomach repair: laparoscopic fundoplication with Vicryl mesh and BioGlue crural reinforcement. Surg Endosc 24, 675–679 (2010). https://doi.org/10.1007/s00464-009-0662-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-009-0662-5

Keywords

Search

Navigation