V.v. Grubnik, Prof, A.v. Malynovskyi, PhD. Odessa national medical university
Introduction. Current techniques of laparoscopic mesh repair of giant hiatal hernias are not effective as rate of recurrence reach 40 %. Thus, creation of fundamentally new methods of prosthetic hiatal repair is necessary.
The aim of the study was to assess long-term results of laparoscopic tension-free repair of giant hiatal hernias with a new prosthesis.
Methods and procedures. From 2010 to 2013, 44 laparoscopic repairs of giant hiatal hernias were performed. From them, 42 patients were followed within mean period of 20,5 ± 3,8 months (range, 14 – 28) using questionnaires, barium study, endoscopic examinations, and 24h pH testing. Mean hiatal surface area (HSA) was 37,5 ± 15,6 cm2 (range, 21,7 – 75,4). Posterior tension-free hiatal repair was performed with new prosthesis – Rebound HRD-Hiatus hernia (Minnesota Medical Development, Inc., USA) which was fixed to crura with 3 – 5 separated sutures. The prosthesis is heart-shaped lightweight polytetrafluorethylene (PTFE) mesh with peripheral nitinol frame. Key advantages of this revolutionary technique are: 1. Peripheral nitinol frame maintaines week tissues of the diaphragm, and, thus, prevents recurrence, 2. Easy fixation, 3. Small risk of oesophageal complications as prosthesis is made from new generation of lightweight PTFE.
Results. All procedures were successfully completed. Mean time of fixation of the prosthesis was 24,8 ± 5,6 min (range, 15 – 35). There were no intra-operative complications associated with the repair. There were 2 symptomatic reflux recurrences (4,7 %), and 3 false (i.e. small, < 2 cm) anatomical recurrences (7,1 %). True anatomical recurrences, and oesophageal strictures and erosions were absent.
Conclusions: This fundamentally new method of laparoscopic repair of giant hiatal hernias is safe and provides absence of true anatomical recurrences in mid-term follow-up period. It apparently requires thorough assessment in long-term follow-up period, with further comparison with other techniques including randomized controlled trials.