TY - JOUR
T1 - Laparoscopic paraesophageal hernia repair with acellular dermal matrix cruroplasty
AU - Diaz, Dennis F.
AU - Scott Roth, J.
PY - 2011/7
Y1 - 2011/7
N2 - Background: Laparoscopic paraesophageal hernia repair (LPEHR) has been shown to be both safe and efficacious. Compulsory operative steps include reduction of the stomach from the mediastinum, resection of the mediastinal hernia sac, ensuring an appropriate intraabdominal esophageal length, and crural closure. The use of mesh materials in the repair of hiatal hernias remains controversial. Synthetic mesh may reduce hernia recurrences, but may increase postoperative dysphagia and result in esophageal erosion. Human acellular dermal matrix (HADM) may reduce the incidence of hernia recurrence with reduced complications compared with synthetic mesh. Methods: A retrospective review of all cases of laparoscopic hiatal hernia repair using HADM from December 2008 through March 2010 at a single institution was performed evaluating demographic information, BMI, operative times, length of stay, and complications. Discussion: Forty-six LPEHRs with HADM were identified. The mean age of patients was 60.3 years (±13.9); BMI 30.3 (±5.3); operative time 182 minutes (±56); and length of stay 2.6 days (±1.9). Nine of 46 (19.6%) patients experienced perioperative complications, including subcutaneous emphysema without pneumothorax (n=2), urinary retention (n=1), COPD exacerbation (n=2), early dysphagia resolving before discharge (n=1), esophageal perforation (n=1), delayed gastric perforation occurring 30 days postoperatively associated with gas bloat syndrome (n=1), and PEG site abscess (n=1). There were 2 clinically recurrent hernias (4.3%). Radiographic recurrences occurred in 2 of 26 patients (7.7%). Six of 46 (13%) patients reported persistent dysphagia. Conclusion: LPEHR with HADM crural reinforcement is an effective method of repairing symptomatic paraesophageal hernias with low perioperative morbidity. Recurrences occur infrequently with this technique. No meshrelated complications were seen in this series.
AB - Background: Laparoscopic paraesophageal hernia repair (LPEHR) has been shown to be both safe and efficacious. Compulsory operative steps include reduction of the stomach from the mediastinum, resection of the mediastinal hernia sac, ensuring an appropriate intraabdominal esophageal length, and crural closure. The use of mesh materials in the repair of hiatal hernias remains controversial. Synthetic mesh may reduce hernia recurrences, but may increase postoperative dysphagia and result in esophageal erosion. Human acellular dermal matrix (HADM) may reduce the incidence of hernia recurrence with reduced complications compared with synthetic mesh. Methods: A retrospective review of all cases of laparoscopic hiatal hernia repair using HADM from December 2008 through March 2010 at a single institution was performed evaluating demographic information, BMI, operative times, length of stay, and complications. Discussion: Forty-six LPEHRs with HADM were identified. The mean age of patients was 60.3 years (±13.9); BMI 30.3 (±5.3); operative time 182 minutes (±56); and length of stay 2.6 days (±1.9). Nine of 46 (19.6%) patients experienced perioperative complications, including subcutaneous emphysema without pneumothorax (n=2), urinary retention (n=1), COPD exacerbation (n=2), early dysphagia resolving before discharge (n=1), esophageal perforation (n=1), delayed gastric perforation occurring 30 days postoperatively associated with gas bloat syndrome (n=1), and PEG site abscess (n=1). There were 2 clinically recurrent hernias (4.3%). Radiographic recurrences occurred in 2 of 26 patients (7.7%). Six of 46 (13%) patients reported persistent dysphagia. Conclusion: LPEHR with HADM crural reinforcement is an effective method of repairing symptomatic paraesophageal hernias with low perioperative morbidity. Recurrences occur infrequently with this technique. No meshrelated complications were seen in this series.
KW - Hiatal hernia
KW - Human acellular dermis
KW - Laparoscopy
KW - Paraesophageal hernia
UR - http://www.scopus.com/inward/record.url?scp=80053623024&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=80053623024&partnerID=8YFLogxK
U2 - 10.4293/108680811X13125733356594
DO - 10.4293/108680811X13125733356594
M3 - Article
C2 - 21985724
AN - SCOPUS:80053623024
SN - 1086-8089
VL - 15
SP - 355
EP - 360
JO - Journal of the Society of Laparoendoscopic Surgeons
JF - Journal of the Society of Laparoendoscopic Surgeons
IS - 3
ER -