Skip to main content
SpringerLink
Log in

Combination of Surgical Technique and Bioresorbable Mesh Reinforcement of the Crural Repair Leads to Low Early Hernia Recurrence Rates with Laparoscopic Paraesophageal Hernia Repair

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Laparoscopic paraesophageal hernia (PEH) is associated with a low morbidity and mortality but an objective hernia recurrence rate in excess of 50% at 5 years. Biologic mesh has not been shown to reduce hernia recurrence rates. Recently, a new bioresorbable mesh made with poly-4-hydroxybutyrate with a Sepra-Technology coating on one side (Phasix-ST mesh) has become available. The aim of this study was to evaluate the feasibility, safety, and short-term efficacy of Phasix-ST mesh for reinforcement of the primary crural closure in patients undergoing elective, laparoscopic PEH repair.

Methods

A prospective database was initiated and maintained for all patients undergoing PEH repair with the use of Phasix-ST mesh. We retrospectively reviewed the records of consecutive patients who had an elective, first-time laparoscopic PEH repair with Phasix-ST mesh and who completed their 1-year objective follow-up study. Patients having a reoperation, non-laparoscopic repair, or who failed to comply with the objective follow-up were excluded.

Results

To achieve the desired 50 patients with 1-year objective follow-up, we reviewed the records of 90 consecutive PEH patients. In the final cohort of 50 patients, there were 32 females (64%) and 18 males. The median age of the patients at surgery was 67 years (range 44–84). The operation was PEH repair with fundoplication alone in 29 patients (58%) and PEH repair with Collis gastroplasty and fundoplication in 21 patients (42%). Phasix-ST mesh was used for crural reinforcement in all patients, and there were no intraoperative issues with the mesh or any difficulty placing or fixating the mesh at the hiatus. A diaphragm relaxing incision was performed in 2 patients (4%). The mean length of hospital stay was 2.8 days, and there was no major morbidity or mortality. On the 1-year objective follow-up study (median 12 months) a recurrent hernia was found in 4 patients (8%). No patient that had a Collis gastroplasty or a relaxing incision had a recurrent hernia. No patient had a reoperation. No patient had a mesh infection or mesh erosion.

Conclusions

Phasix-ST mesh reinforcement of the crural closure during laparoscopic primary, elective PEH repair was associated with no adverse mesh-related events such as infection or erosion. Phasix-ST crural reinforcement in combination with tension-reduction techniques when necessary resulted in a very low (8%) objective hernia recurrence rate at a median follow-up of 1 year. These results demonstrate the safety of Phasix-ST mesh for use at the hiatus for crural reinforcement. This safety, along with the encouraging short-term efficacy for reducing hernia recurrence, should encourage further studies using the combination of resorbable biosynthetic mesh crural reinforcement and tension-reducing techniques during repair of paraesophageal hernias.

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
Fig. 2

Similar content being viewed by others

References

  1. Oelschlager, B.K., et al., Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. [Erratum appears in J Am Coll Surg. 2011 Dec;213(6):815]. J Am Coll Surg, 2011. 213(4):461–8.

    Article  Google Scholar 

  2. Stadlhuber, R.J., et al., Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc, 2009. 23(6):1219–26.

    Article  Google Scholar 

  3. Dallemagne, B., et al., Laparoscopic repair of paraesophageal hernia: long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg, 2011. 253:291–296.

    Article  Google Scholar 

  4. Burger, J.W.A., et al., Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg, 2004. 240(4):578–83.

    PubMed  PubMed Central  Google Scholar 

  5. Granderath, F.A., 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(1):40–8.

    Article  Google Scholar 

  6. Frantzides, C.T., et al., A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg, 2002. 137(6):649–52.

    Article  Google Scholar 

  7. Oelschlager, B.K., et al., Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg, 2006. 244(4):481–90.

    PubMed  PubMed Central  Google Scholar 

  8. Watson, D., et al., Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh. Ann Surg, 2015. 261:282–289.

    Article  Google Scholar 

  9. Maziak, D.E., T.R. Todd, and F.G. Pearson, Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg, 1998. 115(1):53–60.

    Article  CAS  Google Scholar 

  10. Zehetner, J., et al., Laparoscopic wedge fundectomy for collis gastroplasty creation in patients with a foreshortened esophagus. Ann Surg, 2014. 260(6):1030–3.

    Article  Google Scholar 

  11. Davila Bradly, D., et al., Assessment and reduction of diaphragmatic tension during hiatal hernia repair. Surg Endosc, 2015. 29:796–804.

    Article  Google Scholar 

  12. Greene, C.L., et al., Diaphragmatic relaxing incisions during laparoscopic paraesophageal hernia repair. Surg Endosc, 2013. 27(12):4532–8.

    Article  Google Scholar 

  13. Polomsky, M., et al., Association of kyphosis and spinal skeletal abnormalities with intrathoracic stomach: a link toward understanding its pathogenesis. J Am Coll Surg, 2009. 208:562–569.

    Article  Google Scholar 

  14. Deeken, C.R. and B.D. Matthews, Characterization of the mechanical strength, resorption properties, and histologic characteristics of a fully absorbable material (poly-4-hydroxybutyrate-PHASIX mesh) in a porcine model of hernia repair. ISRN Surg, 2013:1–12.

  15. Biondo-Simoes, M., et al., Adhesions on polypropylene versus Sepramesh meshes: an experimental study in rats. Rev Col Bras Cir, 2018. 45:2040.

    Article  Google Scholar 

Download references

Funding

This study was funded by a research grant from Bard/Davol.

Author information

Authors and Affiliations

  1. The Oregon Clinic, 4805 NE Glisan St Suite 6N60, Portland, OR, 97213, USA

    Walaa F. Abdelmoaty, Christy M. Dunst, Filippo Filicori, Ahmed M. Zihni, Daniel Davila-Bradley, Kevin M. Reavis, Lee L. Swanstrom & Steven R. DeMeester

Authors
  1. Walaa F. Abdelmoaty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christy M. Dunst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Filippo Filicori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmed M. Zihni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Davila-Bradley
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kevin M. Reavis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lee L. Swanstrom
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Steven R. DeMeester
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven R. DeMeester.

Ethics declarations

Disclaimer

Oversight of the study, data collection, data analysis, and manuscript preparation were under the direction of Steven R. DeMeester independent of Bard/Davol.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdelmoaty, W.F., Dunst, C.M., Filicori, F. et al. Combination of Surgical Technique and Bioresorbable Mesh Reinforcement of the Crural Repair Leads to Low Early Hernia Recurrence Rates with Laparoscopic Paraesophageal Hernia Repair. J Gastrointest Surg 24, 1477–1481 (2020). https://doi.org/10.1007/s11605-019-04358-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-019-04358-y

Keywords

Search

Navigation