Argenis Herrera, MD, Katy Harris, MD, Gabriel Arevalo, MD, Ibraheem Kayali, Maurice Arregui, MD. St Vincent Hospital
Introduction: Laparoscopic hiatal hernia repair with Nissen fundoplication and primary cruroplasty, recurrence can be as high as 50% long term. Mesh has been used to reinforce the repair in an attempt to reduce the recurrence. Initial reports using biologic mesh have been promising showing an improvement in patient’s symptoms and a reduction in recurrence rates in the short-term. This study presents our experience concerning hiatal hernia repair reinforced with biologic mesh, limited to Surgisis mesh, with long-term follow-up.
Methods: A retrospective analysis of all patients who underwent a Nissen fundoplication with mesh placement from January 2000 – January 2015 was performed. Post-surgical interventions were also identified. Subsequently, a phone interview was performed specifically relating to recurrent symptoms including post-prandial pain, regurgitation, heartburn, dysphagia, and increasing antacid use.
Results: A total of 87 patients were identified during this time period. Follow-up was attained in 46 patients; however 10 of these had biologic mesh placed other than Surgisis, and were therefore, eliminated from this study. The average hernia size was 5 cm with 25 patients who had a large defect measuring > 6 cm. The large majority of patients (97%) had a significant improvement in their symptoms. Eighteen patients (50%) reported taking a single daily antacid. One patient experienced severe dysphagia and vomiting post-operatively requiring multiple EGDs with dilation. There were 5 documented cases of a slipped Nissen and 6 patients with radiologic evidence of hiatal hernia recurrence. However, neither of these radiologic findings correlated to recurrent symptoms. Eight patients required EGD with dilation. There were no complications of mesh erosion reported. Patients had an average follow-up of 6.7 years (ranging 3.6-10.9 years). Overall, 94% of patients would choose to have the surgery again.
Conclusion: Our experience regarding patients who underwent hiatal hernia repair with biologic mesh placement has produced promising results in the 10 year follow up. Symptomatic improvement was overwhelmingly reported, and there were no complications of mesh erosion during this time interval. Post-operative dysphagia occurred in 22% of patients, which resolved with EGD and dilation. However, 0 patients required surgical revision.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77794
Program Number: P396
Presentation Session: Poster (Non CME)
Presentation Type: Poster
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