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Effect of acellular human dermis buttress on laparoscopic hiatal hernia repair

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Abstract

Purpose

The objective of this study was to evaluate the performance of acellular human dermis reinforcement during laparoscopic hiatal hernia repair.

Methods

A prospective non-randomized, single institution study enrolled patients undergoing laparoscopic hiatal hernia repair. Acellular human dermis, FlexHD (Musculoskeletal Transplant Foundation, Edison, NJ) or AlloDerm (LifeCell Inc., Branchburg, NJ) were used to buttress the repair after primary closure. A protocol barium swallow (BAS) was performed at 6 months and then as needed due to clinical indications. Primary outcome measure was recurrence. Patients completed preoperative and postoperative GERD symptom questionnaires and quality of life surveys (SF-36). Kruskal–Wallis ANOVA, Student’s t test, Fisher’s exact test, or Wilcoxon signed-rank test were utilized as appropriate (p < 0.05 considered statistically significant).

Results

Fifty-four patients (10 men and 44 women) with a mean age of 62 ± 10 years underwent laparoscopic hiatal hernia repair using Flex HD (n = 37) or AlloDerm (n = 17). Both groups were similar with respect to gender, age, hiatus size, hernia type [sliding/Type I (n = 14) or paraesophageal/Type III/IV (n = 40)], esophageal motor function (manometry), preoperative SF-36 quality of life surveys, and GERD symptom questionnaires. Forty-seven patients (87 %) completed the BAS at 6 months; each group had two recurrences (p = 0.597). At median follow-up of 33 months, there were 3 recurrences (18 %) in the AlloDerm group and 5 recurrences (14 %) in the Flex HD group (p = 0.365). Minimal differences in GERD symptoms or SF-36 scores were detected between groups. However, anti-reflux medication usage, GERD symptoms, and quality of life significantly improved for both groups after laparoscopic hiatal hernia repair.

Conclusions

Laparoscopic hiatal hernia repair with acellular human dermis reinforcement results in improvement of GERD-related symptoms and quality of life without mesh-associated complications. The type of acellular human dermis did not influence recurrence rate.

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Acknowledgements

This study was supported by a Grant from Musculoskeletal Transplant Foundation (Edison, NJ). The authors would also like to acknowledge the generous assistance of Sharon Phillips in the Vanderbilt University Center for Quantitative Sciences, Department of Biostatistics.

Disclosures

Dr. Deeken has served as a consultant for Atrium Medical Corporation and C. R. Bard, Inc./Davol Inc. and has received honoraria from Covidien and Musculoskeletal Transplant Foundation. Dr. Deeken has also received grant support for unrelated projects from Atrium Medical Corporation, Covidien, Ethicon, Inc., Kensey Nash Corporation, Musculoskeletal Transplant Foundation, OBI Biologics, Inc., and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Ms. Frisella has received funding from Atrium Medical Corporation® and W. L. Gore and Associates® Incorporated for unrelated service contracts; and research grant funding for unrelated studies from the Foundation for Barnes-Jewish Hospital. Dr. L. Michael Brunt has received honoraria from LifeCell Inc. Dr. Matthews has served on advisory boards for Musculoskeletal Transplant Foundation, Covidien® Incorporated, and Synthes® Incorporated; has served as a consultant for Atrium Medical Corporation®; has received speaking fees or honoraria from Atrium Medical Corporation®, Davol® Incorporated, Ethicon® Incorporated, W.L. Gore and Associates® Incorporated; has received payments for authorship of an unrelated publication from McMahon Group® Incorporated; has received research grant funding for unrelated research studies from Covidien® Incorporated, Ethicon® Incorporated, Karl Storz Endoscopy America® Incorporated, Kensey Nash Corporation®, Musculoskeletal Transplant Foundation, Synovis Surgical Innovations®, the Society of American Gastrointestinal and Endoscopic Surgeons, and the National Institutes of Health; and the Foundation for Barnes-Jewish Hospital. Dr. Ward, Mr. Costello, Ms. Baalman, and Dr. Pierce have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. William Beaumont Army Medical Center, El Paso, TX, USA

    Kyle C. Ward

  2. Department of Surgery, Washington University School of Medicine, Washington University in Saint Louis, 660 South Euclid Avenue, Campus Box 8109, St. Louis, MO, 63110, USA

    Kevin P. Costello, Sara Baalman, Corey R. Deeken, Margaret M. Frisella, L. Michael Brunt & Brent D. Matthews

  3. Vanderbilt University Medical Center, Nashville, TN, USA

    Richard A. Pierce

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  1. Kyle C. Ward
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  2. Kevin P. Costello
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  3. Sara Baalman
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  5. Corey R. Deeken
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  6. Margaret M. Frisella
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  7. L. Michael Brunt
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  8. Brent D. Matthews
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Corresponding author

Correspondence to Corey R. Deeken.

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Ward, K.C., Costello, K.P., Baalman, S. et al. Effect of acellular human dermis buttress on laparoscopic hiatal hernia repair. Surg Endosc 29, 2291–2297 (2015). https://doi.org/10.1007/s00464-014-3946-3

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  • DOI: https://doi.org/10.1007/s00464-014-3946-3

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