MEASURING TENSION AT THE DIAPHRAGMATIC CRUS CLOSURE– DESCRIPTION OF A NOVEL TECHNIQUE AND INITIAL FINDINGS

Katharina Fetten, MD¹, Douglas A Cornet, PhD², Sumeet Mittal, MBBS³. ¹St Joseph Hospital Medical Center, ²Principal Biomedical Design Engineer, MicroAire Surgical Instruments, ³Northon Thoracic Institute

OBJECTIVE: Approximation of the diaphragmatic crus pillars is a key step in hiatal hernia repair. The dogma of successful hernia repair requires tension free approximation of tissue. There are no techniques described to measure tension across the crus closure. Aim of this study is to describe a novel technique for measuring the tension exerted on crural sutures and report initial findings.

METHODS: Data was collected at 2 institutions by the same surgeon. After hiatus dissection was complete the crus defect was measured both anterio-posterior and transverse dimension. The crus closure sutures were placed posterior and then lateral to the esophagus. The initial suture is started posteriorly with a figure of eight fashion (#1). With each subsequent stitch placed anteriorly (#2 and #3) or laterally (L1, L2) till adequate hiatus closure is achieved. We measured tension on each suture placed as follows. The tails of each suture are brought out via the laparoscopic port, threading them through the Tie Knot® device (LSI surgical). At this point a hemostat is attached to the suture ends, which allows the hook of a Force Gage [Force Ten FDX, Wagner instruments] to measure the force (in Lbf) across the crural suture as the tie knot device is deployed.

RESULTS: Hiatus defect measurements and tension measurements were available for 21 and 29 patients respectively. Mean age was 56 Yrs with 8 males. Mean BMI was 26 (20-36). Mean AP 5cm (3-8) and T 2.7cm (2-5) diameter. The mean measured force across #1= 0.9 (0.56-1.25) and #2=0.9 (0.3-1.42). Table 1. 

Table 1: AP – anterioposterior diameter (cm), T – transverse diameter (cm), #1 crural suture inferior, #2 crural suture, #3 crural suture, L – lateral

CONCLUSIONS: We have described and presented initial findings of a novel method to measure the force required to approximate the hiatus. Hopefully the technique can be standardized and used to determine the degree of tension. Potentially this could facilitate identification of subset of patients who might benefit from curs prosthetic reinforcement. 

Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87328

Program Number: P490

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster