A Novel Biologic Mesh As Reinforcement of Hiatal Closure During Laparoscopic Paraesophageal Hernia Repair

Eelco B Wassenaar, MD PhD, Carlos A Pellegrini, MD, Brant K Oelschlager, MD. University of Washington

INTRODUCTION
Primary laparoscopic paraesophageal hernia repair (LPEHR) is associated with a very high recurrent hernia rate. Biologic mesh has been shown to reduce (but not eliminate) this recurrence rate in the short run (6 months) but its durability is questioned. Outcomes for the spectrum of biologic materials is limited, therefore, we performed a study to assess the short-term efficacy of a bovine pericardium mesh (BP) (Veritas® collagen matrix, Synovis®, St. Paul MN) in these repairs.
METHODS AND PROCEDURES
Twenty patients with a paraesophageal hernia (> 5 cm) were included in the study. A LPEHR was performed and the hiatus buttressed with BP. A Nissen fundoplication was performed in all patients. A standardized questionnaire and a short-form 36 quality of life score were filled out by all patients before and 6 months after the operation. Six months post-operatively an UGI study was performed.
RESULTS
Median age was 66 years (range 47 – 89), median BMI was 28.7 kg/m2 (21.9 – 40.2) and there were 4 men. One patient died of a cause unrelated to the operation. Nineteen patients filled out the post-operative questionnaire and 16 patients had an UGI. Four of 16 patients (25%) were found to have a recurrence (≥2cm) on UGI. There was a significant improvement in heartburn, regurgitation, and chest pain after LPEHR. Improvement was reported for heartburn in 15 of 16 (94%) patients and of regurgitation in 11 of 15 (73%) patients. Though median dysphagia scores improved, two patients reported worse dysphagia one of which required a dilatation. Overall quality of life improved post-operatively and this improvement was not influenced by having a recurrence or not. Patients with a recurrent hernia were not more likely to have persistent heartburn, regurgitation, dysphagia or chest pain post-operatively.
CONCLUSIONS
Recurrence rate at 6 months after LPEHR using BP mesh was 25%, but recurrence didn’t appear to affect the positive impact of LPEHR. This rate is not lower than expected based on reported biologic mesh repairs, thus can’t recommend this over existing biomaterials.
 

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