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The use of autologous fascia lata graft in the laparoscopic reinforcement of large hiatal defect: initial observations of the surgical technique.

Bjelovic M, Babic T, Spica B, Gunjic D, Veselinovic M, Bascarevic V - BMC Surg (2015)

Bottom Line: Out of 10 patients, 5 completed the annual follow-up visit, while 8 completed a 6- month follow-up visit.So far there is no hernia recurrence and/or problems with swallowing function.However, one patient has felt a mild discomfort in the harvested region that does not influence normal daily activities.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Even though there is no consensus, many authors believe that in the cases of large hiatal defects, structurally altered crura and/or absence of peritoneal lining, a crural reinforcement should be performed. Reinforcement could be performed with different techniques and different type of mesh, either synthetic or biologic. The disadvantages of mesh repair include the possibility of serious complications and increased costs especially in the usage of composite or biologic mesh.

Methods: The study includes 10 cases of reinforced primary suture line of the pillars with autologous fascia lata, in elective laparoscopic repair of the giant PEH with a large hiatal defect and friable crura. After intraopreative confirmation of the large hiatal defect (hiatal surface area of more than 8 cm²) and friable crura, an autologous fascia lata graft was harvested in the usual manner and placed in on-lay fashion to reinforce the pillar suture line. We analyzed surgical technique, complications, and initial follow-up of the patients.

Results: Average hiatal surface area (HSA) in our series was 10.6 cm² (range 8.1 to 14.4 cm²). The average duration of operation was 203.9 min/3.4 hours (range 160-250 min). Except for a mild hematoma in the harvesting region that resolved spontaneously, there were no procedure related complications and 30 days mortality rate was zero. The average postoperative length of stay was 6.5 days (5-8 days). Out of 10 patients, 5 completed the annual follow-up visit, while 8 completed a 6- month follow-up visit. So far there is no hernia recurrence and/or problems with swallowing function. However, one patient has felt a mild discomfort in the harvested region that does not influence normal daily activities.

Conclusions: Autologous fascia lata graft hiatal reinforcement represents a technically feasible, easy, and available option for the on-lay reinforcement of large hiatal defects with friable crura in the laparoscopic repair of giant PEHs.

No MeSH data available.


Related in: MedlinePlus

Autologous fascia lata graft reinforcement of the large hiatal defect; fascia lata in place.
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Fig2: Autologous fascia lata graft reinforcement of the large hiatal defect; fascia lata in place.

Mentions: Primary retroesophageal suture of the pillars was performed. For severely disrupted hiatus a complex reconstruction is required. In such a case the left crus is plicated to normalize the crural length, permitting a standard hiatal reconstruction [14]. Afterwards, an autologous fascia lata graft was placed in on-lay fashion and fixed with biodegradable tacks (Figure 2). There is an issue regarding fascia lata fixation. Solid and slippery surface of the graft, compared to mesh structure, may cause difficulties. However, a proper dissection of the retro-esophageal space allows enough room for the fascia lata deployment. After a proper positioning of the graft, the initial fixation is crucial. First tacks are placed on the most proximal part of the graft allowing the fascia to fall as a curtain over the crural region. While proximal tacks keep the fascia in place, in a step-by-step manner, additional tacks with the fascia lata underneath should be pressed against the surface. At that point, using the grasping forceps, the graft is lifted and folded to check the place of the fixation.Figure 2


The use of autologous fascia lata graft in the laparoscopic reinforcement of large hiatal defect: initial observations of the surgical technique.

Bjelovic M, Babic T, Spica B, Gunjic D, Veselinovic M, Bascarevic V - BMC Surg (2015)

Autologous fascia lata graft reinforcement of the large hiatal defect; fascia lata in place.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359456&req=5

Fig2: Autologous fascia lata graft reinforcement of the large hiatal defect; fascia lata in place.
Mentions: Primary retroesophageal suture of the pillars was performed. For severely disrupted hiatus a complex reconstruction is required. In such a case the left crus is plicated to normalize the crural length, permitting a standard hiatal reconstruction [14]. Afterwards, an autologous fascia lata graft was placed in on-lay fashion and fixed with biodegradable tacks (Figure 2). There is an issue regarding fascia lata fixation. Solid and slippery surface of the graft, compared to mesh structure, may cause difficulties. However, a proper dissection of the retro-esophageal space allows enough room for the fascia lata deployment. After a proper positioning of the graft, the initial fixation is crucial. First tacks are placed on the most proximal part of the graft allowing the fascia to fall as a curtain over the crural region. While proximal tacks keep the fascia in place, in a step-by-step manner, additional tacks with the fascia lata underneath should be pressed against the surface. At that point, using the grasping forceps, the graft is lifted and folded to check the place of the fixation.Figure 2

Bottom Line: Out of 10 patients, 5 completed the annual follow-up visit, while 8 completed a 6- month follow-up visit.So far there is no hernia recurrence and/or problems with swallowing function.However, one patient has felt a mild discomfort in the harvested region that does not influence normal daily activities.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Even though there is no consensus, many authors believe that in the cases of large hiatal defects, structurally altered crura and/or absence of peritoneal lining, a crural reinforcement should be performed. Reinforcement could be performed with different techniques and different type of mesh, either synthetic or biologic. The disadvantages of mesh repair include the possibility of serious complications and increased costs especially in the usage of composite or biologic mesh.

Methods: The study includes 10 cases of reinforced primary suture line of the pillars with autologous fascia lata, in elective laparoscopic repair of the giant PEH with a large hiatal defect and friable crura. After intraopreative confirmation of the large hiatal defect (hiatal surface area of more than 8 cm²) and friable crura, an autologous fascia lata graft was harvested in the usual manner and placed in on-lay fashion to reinforce the pillar suture line. We analyzed surgical technique, complications, and initial follow-up of the patients.

Results: Average hiatal surface area (HSA) in our series was 10.6 cm² (range 8.1 to 14.4 cm²). The average duration of operation was 203.9 min/3.4 hours (range 160-250 min). Except for a mild hematoma in the harvesting region that resolved spontaneously, there were no procedure related complications and 30 days mortality rate was zero. The average postoperative length of stay was 6.5 days (5-8 days). Out of 10 patients, 5 completed the annual follow-up visit, while 8 completed a 6- month follow-up visit. So far there is no hernia recurrence and/or problems with swallowing function. However, one patient has felt a mild discomfort in the harvested region that does not influence normal daily activities.

Conclusions: Autologous fascia lata graft hiatal reinforcement represents a technically feasible, easy, and available option for the on-lay reinforcement of large hiatal defects with friable crura in the laparoscopic repair of giant PEHs.

No MeSH data available.


Related in: MedlinePlus