Laparoscopic Repair of Large & Recurrent Hiatus Herniae with Gore Bio a Mesh: Interim Experience

Ian A Maheswaran, BSc, MBBS, MSc, DIC, MEd, MRCSEng, Anna Conway, BSc, MBBS, MRCSEng, Paras Jethwa, BSc, MBBS, MD, FRCSEng

Surrey and Sussex NHS Trust, Redhill, UK

Introduction:

The aim of this study is to report on the safety and efficacy of a technique utilising a laparoscopic primary crural repair with on-lay fixation of Gore Bio A mesh for large and recurrent hiatus herniae. Repair of large and recurrent hiatus herniae pose significant surgical challenges, controversy and the potential for significant morbidity. There is no consensus on the most appropriate technique leading to varied reports of success in the literature. Radiological recurrence rates are reported at 42% (Granderath et al 2006) whilst true recurrence rates at 25.5% (Rathore et al. 2007). Mesh reinforcement of hiatal repairs does reduce recurrence but concerns around mesh erosion, slippage and extra operating time prevent its widespread use.

Methods:

A total of 19 patients underwent a hiatus hernia repair using Gore Bio A Mesh between June 2009 and September 2012. 16 patients had large (>6cm) hiatal defects and 4 had recurrent hiatal defects in total. At surgery the hiatal defect was closed using interrupted non-absorbable sutures followed by an anterior crural reinforcement using a U shaped Gore Bio A mesh shaped to lie around the oesophagus. All patients then underwent a fundoplication. Patients where then evaluated postoperatively for functional outcomes, symptoms suspicious of recurrence and contrast swallows were performed within six months of surgery. If warranted further endoscopy and pH testing was carried out.

Results:

The mean age of patients was 65 years (46 -84 years) with a M:F ratio of 1:1.37. Mean follow up was 11.4 months (28 – 1 months). All patients were able to tolerate liquids in the post-operative period and nobody underwent dilatation. Follow up to date has not demonstrated any clinical recurrence of pre- operative symptoms. There was one radiological recurrence detected on barium study and one technical failure in the immediate post-operative period.

Conclusion:

In this small series it appears hiatal reinforcement with Gore Bio A mesh is safe, effective and well tolerated. Despite being a bio-absorbable product the medium-short term outcomes are good with a low recurrence rate. This reports our interim experience and therefore longer follow up and comparisons with other mesh repairs in a randomised trial would be beneficial.

Session: Poster Presentation

Program Number: P306