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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

Preparation of gastric fundus for fundoplication.
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fig7: Preparation of gastric fundus for fundoplication.

Mentions: We led the operation with five trocars, after pneumoperitoneum induction by Veress needle positioned in Palmer's point; we introduced the first 12 mm trocar, for optical system, in mesogastric region 2 cm over the umbilicus. Other two operative 10 mm trocars were placed on the left and the right side 4 cm away from the first; in the end, the last two 5 mm trocars were placed in xiphoid region, for liver divarication, and in pararectal left of subumbilical region for stomach's retraction (Figure 2). After accurate exploration of the all abdominal cavity specially the diaphragmatic abdominal side, to exclude other pathologies, such as diaphragmatic endometriosis [22], we sectioned the phrenoesophageal membrane to expose and reduced hernia's sac; anterior vagus nerve was identified. Then, left and right crura were exposed and a retroesophageal window was created, having care to identify the posterior vagus nerve; webbing was passed under esophagus and it was retracted to the low. After correct and complete diaphragmatic pillars exposition, two nonabsorbable suture size 0 were given to primary closure of the esophageal hiatus [23, 24]. Its function was only to approach the pillars, not for primary lock, trying to evitate any tension. Subsequently Gore Bio-A Tissue Reinforcement absorbable mesh with a “U” shape was positioned to reinforce hiatoplasty (Figure 3). We had care in the correct positioning of the mesh, but nonperfect accommodation of it in the right anatomic region led us to remodeling the mesh so it could better sit over the crura. We paid attention so as not to make contact between the mesh and esophageal wall, positioning it to a 1 cm of distance, to exclude compressive or erosive events to the organ. We put it under posterior esophageal wall over the crura, fixing it with two absorbable 2/0 size suture, to prevent later dislocation or migration (Figure 4). In the end, a Nissen fundoplication was realized with a wrap of 2 cm long (Figure 7). The mesh had its memory but it was handily and very simple to introduce and place. It can be modeled to shape adjustment and better allocation. All the procedure does not enlarge operative time and does not add complication. There was no blood leak. No aspiration drainage was 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)

Preparation of gastric fundus for fundoplication.
© Copyright Policy
Related In: Results  -  Collection

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

fig7: Preparation of gastric fundus for fundoplication.
Mentions: We led the operation with five trocars, after pneumoperitoneum induction by Veress needle positioned in Palmer's point; we introduced the first 12 mm trocar, for optical system, in mesogastric region 2 cm over the umbilicus. Other two operative 10 mm trocars were placed on the left and the right side 4 cm away from the first; in the end, the last two 5 mm trocars were placed in xiphoid region, for liver divarication, and in pararectal left of subumbilical region for stomach's retraction (Figure 2). After accurate exploration of the all abdominal cavity specially the diaphragmatic abdominal side, to exclude other pathologies, such as diaphragmatic endometriosis [22], we sectioned the phrenoesophageal membrane to expose and reduced hernia's sac; anterior vagus nerve was identified. Then, left and right crura were exposed and a retroesophageal window was created, having care to identify the posterior vagus nerve; webbing was passed under esophagus and it was retracted to the low. After correct and complete diaphragmatic pillars exposition, two nonabsorbable suture size 0 were given to primary closure of the esophageal hiatus [23, 24]. Its function was only to approach the pillars, not for primary lock, trying to evitate any tension. Subsequently Gore Bio-A Tissue Reinforcement absorbable mesh with a “U” shape was positioned to reinforce hiatoplasty (Figure 3). We had care in the correct positioning of the mesh, but nonperfect accommodation of it in the right anatomic region led us to remodeling the mesh so it could better sit over the crura. We paid attention so as not to make contact between the mesh and esophageal wall, positioning it to a 1 cm of distance, to exclude compressive or erosive events to the organ. We put it under posterior esophageal wall over the crura, fixing it with two absorbable 2/0 size suture, to prevent later dislocation or migration (Figure 4). In the end, a Nissen fundoplication was realized with a wrap of 2 cm long (Figure 7). The mesh had its memory but it was handily and very simple to introduce and place. It can be modeled to shape adjustment and better allocation. All the procedure does not enlarge operative time and does not add complication. There was no blood leak. No aspiration drainage was 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