Lauren Rabach, MD, Sarah Keville, BS, Adham Saad, MD, Vic Velanovich, MD. University of South Florida
Background: Paraesophageal hernia (PEH) and recurrent hiatal hernia (RHH) with mesh utilization is performed for patients with large symptomatic hiatal hernias and/or reflux. The urinary bladder matrix surgical device (UBMSD) for PEH/RHH repair has shown promising results. U-shaped and keyhole are the two most commonly used configurations; however, there is little data comparing them. We report here our experience with these two configurations of this mesh.
Methods: A review of PEH repairs between 2013 and 2018 was performed from a single institution. Patients with PEH/RHH that required mesh placement were identified and analyzed for demographic information, perioperative/intraoperative details, and postoperative outcomes.
Results: Of the patients undergoing PEH/RHH repair, 110 were repaired with UBMSD. Of these, 88 were repaired with the U-shaped configuration, while 22 the keyhole configuration. Of the U-shaped configuration patients, 70% were for PEH, 28% for RHH, 1% for a type I HH; while of the keyhole-shaped patients, 73% were for PEH and 27% for RHH. The median follow-up time was 8 weeks. There was no difference in in-hospital complication rates, 20% vs 18%, respectively. However, 24% of patients with the U-shaped configuration recurred, compared to 9% of patients with the keyhole configuration. The average time for recurrence in our patient cohort was around 14 months postoperatively. Postoperative bloating and dysphagia was seen in 6% of our patients, however all of them had the U-shaped mesh configuration. 42% (8 of 19) of the U-shaped patients underwent repair of the recurrence. Of note, the recurrences were found anterior and to the left of the esophagus at an area uncovered by the mesh. Both of the patients with recurrences after the keyhole configuration had repairs.
Conclusion: In conclusion, there was no difference in complication rates between the configuration types. The keyhole configuration may carry lower risk of recurrent hernia. Postoperative dysphagia and bloating may also be lower in the keyhole configuration. Site of recurrence of the U-shaped configuration appeared to be in the region of the hiatus not covered by the mesh.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94377
Program Number: P509
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster