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Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience
Chad D Ringley1, Victor Bochkarev, Syed I Ahmed
1Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA.
American Journal of Surgery
|December 13, 2006
Summary
Reinforcing large hiatal hernia repair with an acellular dermal matrix patch shows promise in reducing recurrence rates. This biodegradable approach may avoid complications associated with non-degradable mesh, offering a potentially safer option for patients undergoing laparoscopic antireflux surgery.
Area of Science:
- Gastroenterology and Surgical Innovation
- Minimally Invasive Surgery
- Biomaterials in Surgery
Background:
- Laparoscopic repair of large hiatal hernias with antireflux procedures is standard for GERD.
- Recurrent herniation and wrap migration are common causes of surgical failure.
- Non-biodegradable mesh patches can lead to complications like erosion, dysphagia, and chest pain.
Purpose of the Study:
- To compare the efficacy and safety of hiatal closure using a biodegradable acellular dermal matrix patch versus simple suture cruroplasty.
- To evaluate the impact on hiatal hernia recurrence and postoperative outcomes in patients undergoing laparoscopic antireflux surgery.
Main Methods:
- Prospective study of 44 patients with large hiatal hernias (>5 cm) undergoing fundoplication.
- Group 1: Primary suture cruroplasty only (n=22).
- Group 2: Suture cruroplasty reinforced with an onlay acellular dermal matrix patch (n=22).
- Comparison of demographics, hernia size, pre/postoperative symptoms, pH studies, operative times, and recurrence rates.
Main Results:
- Both groups showed significant improvement in postoperative pH studies and symptoms.
- No significant difference in postoperative dysphagia between groups; two patients required esophageal dilatation for mild dysphagia.
- Hiatal hernia recurrence (Nissen failure) occurred in 9% (2 patients) in the suture-only group; no recurrences were observed in the acellular dermal matrix group during follow-up.
- No major complications or significant differences in operative time or hospitalization were noted.
Conclusions:
- Acellular dermal matrix patch reinforcement may decrease the incidence of recurrent hiatal herniation and wrap migration.
- Early results suggest this biodegradable patch avoids complications associated with non-degradable mesh, such as erosion, dysphagia, and chest pain.
- Further investigation and longer follow-up are needed to confirm the material's efficacy and safety for this application.
