A Simplified Technique for Intrathoracic Stomach Repair: Laparoscopic Fundoplication with Vicryl Mesh and Bioglue Crural Reinforcement

Background: The laparoscopic repair of an intrathoracic stomach has been associated with a high recurrence rate of up to 50%. Studies describing the use of biological and non-absorbable mesh report a more durable repair. The aim of our study was to assess a simplified technique for intrathoracic stomach repair using absorbable vicryl mesh and bioglue for crural reinforcement.
Methods: In a retrospective chart review, all patients that underwent laparoscopic repair of an intrathoracic stomach from June 2006 to May 2008 using this new simplified technique were included in this study. Intrathoracic stomach was defined as >50% of the stomach herniated into the chest. All patients had undergone laparoscopic reduction of the stomach and hernia sac, nissen fundoplication and crural closure using ethibond suture. The crural closure was reinforced by using an on-lay vicryl mesh that was secured using bioglue only. No sutures or tacks were used to secure the mesh. Follow up was routinely done at 1 year post-op and included upper endoscopy (EGD), videoesophagogram (VEG), Bravo 48h pH and GERD-HRQL.
Results: A total of 25 patients (M:F=7:18) underwent repair using this technique with a mean age of 72.7yrs (51–89) and a mean BMI of 30.2 kg/m2 (20.4–44.8). 22 were completed laparoscopically and 3 patients were converted to open. Mean operating time was 148min (101-245) with a median hospital stay of 3 days (1-8). Complications were bougie perforation in 1 patient repaired after conversion to open and pneumothorax in another treated by chest tube placement. Postoperative 1yr follow-up has been obtained in 14 patients (mean follow-up 16.7 months (11-28). Symptoms were gas/bloating in 3 patients and mild dysphagia in 2 patients. There were no symptomatic recurrences with a mean GERD-HRQL of 5.5 (2-15). 93% of patients were satisfied and 100% would have the operation again. EGD identified one patient with a 2cm asymptomatic paraesophageal hernia. There were no recurrences by VEG and all patients had normal 48 hr pH composite score.
Conclusion: Laparoscopic repair of an intrathoracic stomach with this new technique of crural reinforcement using vicryl mesh and bioglue is simple and appears durable with a low recurrence rate at 1 year follow-up. Long term follow-up is underway to confirm these encouraging preliminary results.

Session: Podium Presentation

Program Number: S036

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