Abstract
Background
Many studies have shown that the importance of using mesh for paraesophageal hernia repair (PEHR) is to prevent recurrence. Unfortunately, it is associated with high risk of complications such as esophageal or gastric erosion. The aim of this study is to report the results of 38 patients who underwent laparoscopic PEHR with the use of a BioSynthetic mesh (GoreÒ Bio AÒ tissue Reinforcement.USA).
Methods
Observational, retrospective, single-center cohort study. We analysed retrospectively 38 consecutive patients with diagnosis of symptomatic Hiatal Hernia (HH) treated laparoscopically with an absorbable BioSynthetic mesh, between 2011–2017. The classic radiologic classification was used to classify the HH before surgery. This classification consists in four types/stages (I-IV). I: Sliding HH, II: Paraesophageal HH, III: Mixed form and IV: Intrathoracic stomach—upside-down hernia. All patients with Type III—IV hiatal hernia who underwent laparoscopic PEHR using an absorbable BioSynthetic mesh were included. We evaluated the results after PEHR with a symptoms questionnaire using a score 0–4 (Likert scale) and with an esophagogram and an esophagogastroduodenoscopy (EGD) analyzing the surgical success. Success was considered with symptomatic score improvement and/or absence of any symptomatic HH at the esophagogram and/or EGD.
Results
38 patients: 7 males and 31 women. Median age: 66 (range 40–71). 12/38 (31,6%) patients had a type III HH and 26/38 (68,4%) a type IV. All these patients had been treated with a laparoscopic PEHR, using an absorbable BioSynthetic mesh as a reinforcement of the crura and Nissen fundoplication. The median follow-up was 12 months. 16/38 (42%) had a follow-up > 24 months. Success was evident in 95% of the patients. We observed 2 recurrences, one with a symptomatic type I HH and the other with an early type III HH recurrence.
Conclusion
The use of an absorbable synthetic mesh as a reinforcement of the crura in the treatment of the PEH has encouraging good results in the mild term follow up, with an extremely low incidence of complications.
Disclosure
All authors have declared no conflicts of interest.
Abdome Agudo Obstrutivo por hérnia hiatal tipo IV – Um relato de caso / Obstructive acute abdomen for type IV hiatal hernia – A case report