Limits...
Hiatal hernia repair with gore bio-a tissue reinforcement: our experience.

Antonino A, Giorgio R, Giuseppe F, Giovanni de V, Silvia DG, Daniela C, Giuseppe DB, Vincenzo S, Gaspare G - Case Rep Surg (2014)

Bottom Line: Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones.Conclusion.However, further data and studies are needed to evaluate long-term outcomes.

View Article: PubMed Central - PubMed

Affiliation: Dipartimento di Chirurgia Generale d'Urgenza e dei Trapianti d'Organo., U.O.C Chirurgia Generale e d'Urgenza, Azienda Ospedaliera Policlinico Universitario "Paolo Giaccone", Via Liborio Giuffrè 28, Palermo, 90100 Sicily, Italy.

ABSTRACT
Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50-90% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore. Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH study was positive for acid reflux; esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic approach, the hiatal hernia defect was identified and primarily repaired, by crural closure. Gore Bio-A Tissue Reinforcement was trimmed to fit the defect accommodating the esophagus. Nissen fundoplication was performed. Result. Bio-A mesh was easily placed laparoscopically. It has good handling and could be cut and tailored intraoperatively for optimal adaptation. There were no short-term complications. Conclusion. Crural closure reinforcement can be done readily with this new totally absorbable mesh replaced by soft tissue over six months. However, further data and studies are needed to evaluate long-term outcomes.

No MeSH data available.


Related in: MedlinePlus

Gore Bio-A Tissue Reinforcement.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4016863&req=5

fig5: Gore Bio-A Tissue Reinforcement.

Mentions: Gore Bio-A Tissue Reinforcement is a 3D web of completely absorbable synthetic polymers replaced by soft tissue over six months [17, 24] (Figure 5); It is a mix of glycolic acid and trimethylene carbonate and its function is, rather than making a mechanical barrier, stimulating collagens deposition and ingrowths of new connective soft tissue (Figure 6). It was demonstrated that Gore Bio-A increase cellular in-growth in 7–30 days more and more previously than biologics mesh; it also increase new blood vessels formation in 7–14 days reaching the greatest vascular in growth. Instead, the biologic meshes of Gore Bio-A seem to induce the least inflammatory infiltrate. The preformed shape is useful to hiatal hernia repair and its structure made it handy and easy to allocate or modify to a better positioning. To prevent dislocation it can be fixed with absorbable point to the crura or using biologic glues. Our experience was positive above all, because in the 2-month follow-up the patient seems to be going well; she had no more GERD symptoms, no gas bloat syndrome, or bleaching and most importantly no dysphagia was referred. It is clear that Gore Bio-A Tissue Reinforcement seems to have all the best characteristics to hernia hiatal laparoscopic repair reducing both recurrence rates and postoperative mesh related complications, even if several other cases and studies are necessary.


Hiatal hernia repair with gore bio-a tissue reinforcement: our experience.

Antonino A, Giorgio R, Giuseppe F, Giovanni de V, Silvia DG, Daniela C, Giuseppe DB, Vincenzo S, Gaspare G - Case Rep Surg (2014)

Gore Bio-A Tissue Reinforcement.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016863&req=5

fig5: Gore Bio-A Tissue Reinforcement.
Mentions: Gore Bio-A Tissue Reinforcement is a 3D web of completely absorbable synthetic polymers replaced by soft tissue over six months [17, 24] (Figure 5); It is a mix of glycolic acid and trimethylene carbonate and its function is, rather than making a mechanical barrier, stimulating collagens deposition and ingrowths of new connective soft tissue (Figure 6). It was demonstrated that Gore Bio-A increase cellular in-growth in 7–30 days more and more previously than biologics mesh; it also increase new blood vessels formation in 7–14 days reaching the greatest vascular in growth. Instead, the biologic meshes of Gore Bio-A seem to induce the least inflammatory infiltrate. The preformed shape is useful to hiatal hernia repair and its structure made it handy and easy to allocate or modify to a better positioning. To prevent dislocation it can be fixed with absorbable point to the crura or using biologic glues. Our experience was positive above all, because in the 2-month follow-up the patient seems to be going well; she had no more GERD symptoms, no gas bloat syndrome, or bleaching and most importantly no dysphagia was referred. It is clear that Gore Bio-A Tissue Reinforcement seems to have all the best characteristics to hernia hiatal laparoscopic repair reducing both recurrence rates and postoperative mesh related complications, even if several other cases and studies are necessary.

Bottom Line: Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones.Conclusion.However, further data and studies are needed to evaluate long-term outcomes.

View Article: PubMed Central - PubMed

Affiliation: Dipartimento di Chirurgia Generale d'Urgenza e dei Trapianti d'Organo., U.O.C Chirurgia Generale e d'Urgenza, Azienda Ospedaliera Policlinico Universitario "Paolo Giaccone", Via Liborio Giuffrè 28, Palermo, 90100 Sicily, Italy.

ABSTRACT
Type I hiatal hernia is associated with gastroesophageal reflux disease (GERD) in 50-90% of cases. Several trials strongly support surgery as an effective alternative to medical therapy. Today, laparoscopic fundoplication is considered as the procedure of choice. However, primary laparoscopic hiatal hernia repair is associated with upto 42% recurrence rate. Mesh reinforcement of the crural closure decreases the recurrence but can lead to complications, above all nonabsorbable ones. We experiment a new totally absorbable mesh by Gore. Case. We present a case of a 65-year-old female patient with a 6-year classic history of GERD. Endoscopy revealed a large hiatal hernia and esophagitis. pH study was positive for acid reflux; esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic approach, the hiatal hernia defect was identified and primarily repaired, by crural closure. Gore Bio-A Tissue Reinforcement was trimmed to fit the defect accommodating the esophagus. Nissen fundoplication was performed. Result. Bio-A mesh was easily placed laparoscopically. It has good handling and could be cut and tailored intraoperatively for optimal adaptation. There were no short-term complications. Conclusion. Crural closure reinforcement can be done readily with this new totally absorbable mesh replaced by soft tissue over six months. However, further data and studies are needed to evaluate long-term outcomes.

No MeSH data available.


Related in: MedlinePlus