Miguel A Hernandez, MD, Morris E Franklin Jr., MD, FACS. Texas Endosurgery Institute
Different randomized studies have demonstrated the need to use a prosthesis in the repair of a hiatal hernia. Recurrence rates drop dramatically when a mesh is applied. However there is still controversy regarding what prosthesis should be used and how to place it .
From January 2001 to September 2014, all patients having hiatal hernia and gastroesophageal reflux disease that underwent laparoscopic hiatal hernia repair with porcine-bowel submucosa mesh (Biodesign) placement were prospectively studied. Indications for the use of prosthetic material included: recurrent hiatal hernia, crus defect > 5 cm, obesity, chronic pulmonary disease, impaired healing (lupus, >80 years old), and incarcerated hernia.
One hundred and eighty patients were analyzed, 49% of patients were female and 51% male; the mean age was 60.1 years (32-91 years). Mean operating time was 167 minutes with a range of 75-400 minutes. EBL was 28 ml (50-100 ml). One third of patients (34%) had extensive adhesions present within the hiatal hernia. One patient required conversion secondary to these adhesions. All the patients had a follow up of 6 months, 91% of 1 year, 83% of 2 years, 65% of 3 years 52% of 4 years and more than 5 years 39%. Recurrence was seen in only one patient (0.5%). There were no complications related to prostheses placement. The mortality rate was 0%.
Laparoscopic placement of Biodesing in the hiatus, at the time of laparoscopic repair, is a safe and effective measure to prevent recurrence of hiatal hernia.