Paraesophageal Repair Using Bovine Pericardium Mesh

Jesus N Vasquez, MD, Sergio Diaz, MD, Maria J Correa, MD, Lina Giraldo, MD, Sebastian Sierra, MD, Ricardo Londono, MD, Juan D Wolff, MD, Juan P Toro, MD, Silvia Medina, Nurse

General Surgery Department, Hospital Manuel Uribe Angel, Envigado-Antioquia, Colombia. Santa Maria Cardiovascular Clinic, Antioquia, Colombia.

INTRODUCTION:
The objective of the present study is to evaluate our experience with the surgical management of patients with paraesophageal hernia (PEH) using bovine pericardium (Clinica cardiovascular, Medellin, Colombia). We analized the demographic characteristics, type of hernia, main simptoms, surgical technique, complications, and simptomatic and anatomic recurrence.

METHODS AND PROCEDURES:
Case series study. We retrospectively analized 25 patients that underwent PEH repair surgery during a period of 7 years in different hospitals of Medellin (country: Colombia) using a biosynthetic mesh.

RESULTS:
Twenty five patients underwent laparoscopic GHH repair. None of them required convertion to open surgery. In every case the hernia sac was resected, and the hernia defect was primarily closed and reinforced with a bovine pericardium mesh. The mean age was 61.3 years. The main symptom was regurgitation (32%) followed by heartburn and chest pain (28% each). 52% had an objective diagnosis of GERD. The vast majority of patients had a type III hiatal hernia (n=23) and only 2 had a type IV HH (both with herniated colon and small bowel). The duration of surgery was 131.9 minutes in average. There were no intraoperative complications. Five patients had a postoperative complication, none of them requiring reoperation (abdominal bleeding: 2, intrapleural abscess:1, atelectasis: 1, transitory disphagia:1). The mean lenght of stay was 2.47 days. Short and medium term follow up was achieved in 64% of patients both in a postoperative clinic visit and then by a telephone call. Anatomic recurrence was observed in 3 patients and the sintomatic recurrence was classified with the Visick score with the following results: I: 40% (10 patients), II: 12% (3 patients), III:16% (4 patients), IV: 4% (1 patient).

CONCLUSIONS:
Biologic mesh reinforcement of giant hiatal hernia repair with bovine pericardium is a safe option, with a low rate of complications and symptomatic recurrence.

Session: Poster Presentation

Program Number: P311