• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Histologic Analysis of Gore® Bio-A® Tissue Reinforcement Six Months After Implantation in Laparoscopic Paraesophageal Hernia Repair

Jeffrey S Mandel, MD FACS. Savannah Surgical Oncology, Savannah, GA

Compared with open surgical procedures, laparoscopic repair of paraesophageal hernias (PEH) has been associated with a more rapid recovery, a shorter hospital stay, less pain, and fewer perioperative complications. Prosthetic mesh is routinely implanted during PEH repairs with the aim of mitigating hernia recurrence, but commonly used nonabsorbable materials may, over time, erode into the esophageal tissue and/or cause esophageal stenosis, fibrosis, dysphagia, and pain. “Biologic” prostheses, which are composed of human (cadaver) or animal tissue, provide a bioabsorbable alternative to the permanent presence of a foreign body, but these materials may have a limited shelf life, high cost, or require special preparation in the operating room (soaking, stretching). Biologic prostheses have also been reported to be associated with an increased risk of recurrence.
A new option for PEH repairs is GORE® BIO-A® Tissue Reinforcement, a bioabsorbable material that is composed of a web of synthetic polymers. The web is similar to the extracellular matrix in biologic materials and undergoes hydrolytic degradation, leaving behind no material that should cause late complications. Since June 2009, I have used this product to repair 14 PEHs and to reinforce the hiatal repair of 31 Nissen fundoplications, with good results and no reported recurrences. Herein is described a histological analysis of a sample of the material that was obtained six months after implantation during a PEH repair.
The patient was a 71-year-old woman who underwent laparoscopic PEH repair with Nissen fundoplication. There were no operative or postoperative complications. Postoperatively, the patient had both complete resolution of her reflux symptoms and increased exercise tolerance. However, six months later the patient was diagnosed with gallbladder disease and a laparoscopic cholecystectomy was performed. The patient consented to laparoscopic biopsy of the PEH repair site during the cholecystectomy.
The histologic assessment of the repair-site specimen showed dense fibrocollagenous tissue with scattered clusters of lymphocytes and rare foreign-body giant cells. The middle region of the tissue was extensively vascular, with the vascularity bordered by fatty tissue. A few remnants of the prosthesis were present, surrounded or covered by fibrovascular tissue with fibroblasts. Foreign-body giant cells and histiocytes were adjacent to the remnants. There was no evidence of bacteria or mineralization.
To my knowledge, this is the first report of a clinical “second look” at an implanted GORE® BIO-A® Tissue Reinforcement. Overall, the histologic study showed that the material was almost completely absorbed by six months and replaced by fibrovascular tissue, findings which indicated that the prosthesis had encouraged new tissue ingrowth and that a foreign body was no longer present. This case suggests that use of GORE® BIO-A® Tissue Reinforcement may avoid long-term complications associated with the use of nonabsorbable mesh for PEH repair. GORE® BIO-A® Tissue Reinforcement is a unique synthetic mesh in that its resorbability has the advantages of a biologic mesh without the disadvantages of limited shelf life, high cost, or need for preparation. Thus, further studies of the role of this prosthesis in reducing hernia recurrences after laparoscopic PEH repair are warranted.


Session: Poster
Program Number: P097
View Poster

1,961

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons