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Surgical treatment of large and complicated hiatal hernias with the new resorbable mesh with hydrogel barrier (Phasix™ ST): a preliminary study

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Evaluation of the efficacy and safety of the new monofilament fully resorbable mesh with hydrogel barrier (Phasix™ ST), for large and complex hiatal hernia repair. Between December 2017 and December 2020, 60 patients with large or complicated hiatal hernia were treated (40 robotic and 20 laparoscopic procedures). The mesh was placed after primary closure of the hiatal defect, in an onlay fashion around the esophagus, followed by 360o fundoplication. Follow-up at 3, 6, 12, 18, 24 months from intervention included clinical evaluation and upper GI endoscopy. In cases of recurrence, radiologic survey and manometry were utilized. There were no conversions to open repair or significant postoperative incidents. Over a median follow-up of 21 months (range 3–36), no recurrences or mesh related complications were observed. From our early experience, Phasix™ ST mesh seems to be safe and effective for the reinforcement of crural defects in large and complex hiatal hernia.

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  1. Hatlebakk JG, Zerbib F, Bruley des Varannes S, Attwood SE, Ell C, Fiocca R, Galmiche JP, Eklund S, Långström G, Lind T, Lundell LR, LOTUS Study Group (2016) Gastroesophageal acid reflux control 5 years after antireflux surgery, compared with long-term esomeprazole therapy. Clin Gastroenterol Hepatol 14:678–685

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Diaz S, Brunt LM, Klingensmith ME, Frisella PM, Soper NJ (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 7:59–67

    Article  PubMed  Google Scholar 

  4. Asti E, Lovece A, Bonavina L, Milito P, Sironi A, Bonitta G et al (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

    Article  PubMed  Google Scholar 

  5. Huddy JR, Markar SR, Ni MZ, Morino M, Targarona EM, Zaninotto G, Hanna GB (2016) Laparoscopic repair of hiatus hernia: does mesh type influence outcome? A meta-analysis and European survey study. Surg Endosc 30:5209–5221

    Article  PubMed  Google Scholar 

  6. Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD, Guidelines Committee SAGES (2013) Guidelines for the management of hiatal hernia. Surg Endosc 27:4409–4428

    Article  PubMed  Google Scholar 

  7. Carrott PW, Hong J, Kuppusamy M, Kirtland S, Koehler RP, Low DE (2012) Repair of giant paraesophageal hernias routinely produces improvement in respiratory function. J Thorac Cardiovasc Surg 143:398–404

    Article  PubMed  Google Scholar 

  8. 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 

  9. Standlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG et al (2009) Mesh complications after prosthetic reinforcement of hiatal closure: 28-case series. Surg Endosc 23:1219–1226

    Article  Google Scholar 

  10. Roth JS, Anthone GJ, Selzer DJ, Poulose BK, Bittner JG, Hope WW, Dunn RM, Martindale RG, Goldblatt MI, Earle DB, Romanelli JR, Mancini GJ, Greenberg JA, Linn JG, Parra-Davila E, Sandler BJ, Deeken CR, Voeller GR (2018) Prospective evaluation of poly-4-hydroxybutyrate mesh in CDC class I/high-risk ventral and incisional hernia repair: 18-month follow-up. Surg Endosc 32:1929–1936

    Article  PubMed  Google Scholar 

  11. Jay AP, Watson DI (2010) Changing work patterns for benign upper gastrointestinal and biliary disease: 1994–2007. ANZ J Surg 80:519–525

    Article  PubMed  Google Scholar 

  12. Koch OO, Asche KU, Berger J, Weber E, Granderath FA, PointnerR, (2011) Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc 25:1024–1030

    Article  PubMed  Google Scholar 

  13. Mitiek MO, Andrade RS (2010) Giant hiatal hernia. Ann Thorac Surg 89:2168–2173

    Article  Google Scholar 

  14. Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z et al (2013) Guidelines for the management of hiatal hernia. Surg Endosc 27:4409–4428

    Article  PubMed  Google Scholar 

  15. Weyhe D, Klinge U, Uslar VN, Tabriz N, Kluge A (2019) Follow up data of MRI-visible synthetic meshes for reinforcement in large hiatal hernia in comparison to none-mesh repair—a prospective cohort study. Front Surg 6:17

    Article  PubMed  PubMed Central  Google Scholar 

  16. Weitzendorfer M, Pfandner R, Antoniou SA, Schwaiger-Hengstschläger C, Emmanuel K, Koch OO (2019) Short-term results after laparoscopic repair of giant hiatal hernias with pledgeted sutures: a retrospective analysis. Hernia 23:397–401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Oelschlager BK, Petersen RP, Brunt LM, Soper NJ, Sheppard BC, Mitsumori L, Rohrmann C, Swanstrom LL, Pellegrini CA (2012) Laparoscopic paraesophageal hernia repair: defining long- term clinical and anatomic outcomes. J Gastrointest Surg 16(3):453–459

    Article  PubMed  Google Scholar 

  18. Dallemagne B, Kohnen L, Perretta S, Weerts J, Markiewicz S, Jehaes C (2011) Laparoscopic repair of paraesophageal hernia: long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg 253:291–296

    Article  PubMed  Google Scholar 

  19. Milito P, Zanghì S, Sironi A, Asti E, Bonavina L (2019) Very long-term (5–19 years) follow-up of paraesophageal hernia repair: permanent mesh vs standard cruroplasty. Dis Esophagus 32(2):doz092.168

    Article  Google Scholar 

  20. Gillian GK, Bansal D (2019) Retrospective Review and prospective follow-up of 85 consecutive patients treated with a novel hepatic-derived surgical mesh for hiatal hernia repair: outcomes, surgical complications, and revisions. Surg Laparosc Endosc Percutaneous Tech 29(6):529–533

    Article  Google Scholar 

  21. Asti E, Sironi A, Bonitta G, Lovece A, Milito P, Bonavina L (2017) Crura augmentation with Bio-A® mesh for laparoscopic repair of hiatal hernia: single-institution experience with 100 consecutive patients. Hernia 21:623–628

    Article  CAS  PubMed  Google Scholar 

  22. Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: longterm follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213:461–468

    Article  PubMed  Google Scholar 

  23. Watson DI, Thompson SK, Devitt PG, Smith L, Woods SD, AlyA GS, Game PA, Jamieson GG (2015) Laparoscopic repair of very large hiatal hernia with sutures versus absorbable mesh versus non-absorbable mesh: a randomized controlled trial. Ann Surg 261:282–289

    Article  PubMed  Google Scholar 

  24. Li J, Cheng T (2019) Mesh erosion after hiatal hernia repair: the tip of the iceberg? Hernia 23:1243–1252

    Article  CAS  PubMed  Google Scholar 

  25. Sánchez-Pernaute A, Pérez-Aguirre ME, Pérez Jiménez A, Ruano Campos A, Muñoz A, Torres A (2019) Intraluminal mesh erosion after prosthetic hiatoplasty: incidence, management, and outcomes. Dis Esophagus 32(7):doy131.

    Article  PubMed  Google Scholar 

  26. Lattuada E, Zappa MA, Mozzi E, Fichera G, Granelli P, De Ruberto F, Antonini I, Radaelli S, Roviaro G (2007) Band erosion following gastric banding: how to treat it. Obes Surg 17(3):32–333

    Article  Google Scholar 

  27. Chisholm J, Kitan N, Toouli J, Kow L (2011) Gastric band erosion in 63 cases: endoscopic removal and rebanding evaluated. Obes Surg 21(11):1676–1681

    Article  PubMed  Google Scholar 

  28. Yao G, Liu K, Fan Y (2014) Robotic Nissen fundoplication for gastro-esophageal reflux disease: a meta-analysis of prospective randomized controlled trials. Surg Today 44(8):1415–1423

    Article  PubMed  Google Scholar 

  29. Soliman BG, Nguyen DT, Chan EY, Chihara RK, Meisenbach LM, Graviss EA, Kim MP (2019) Robot-assisted hiatal hernia repair demonstrates favorable short-term outcomes compared to laparoscopic hiatal hernia repair. Surg Endosc. (Epub ahead of print)

    Article  PubMed  Google Scholar 

  30. RoldánBaños S, Ruiz de Angulo Martín D, Munítiz Ruiz V, Martínez de Haro L, ParrillaParicio P (2014) Dumping syndrome with severe hypoglycemia after Nissen fundoplication in adults. Case report and literature review. Endocrinol Nutr 61(10):550–551

    Google Scholar 

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Both authors attending surgeons of the cases studied.

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Correspondence to Christos Charisis.

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Haris Konstantinidis and Christos Charisis declare that they have no conflict of interest.

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Konstantinidis, H., Charisis, C. Surgical treatment of large and complicated hiatal hernias with the new resorbable mesh with hydrogel barrier (Phasix™ ST): a preliminary study. J Robotic Surg 17, 141–146 (2023).

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