Primary Closure of Hiatal Defects Using a Unidirectional Barbed Suture With and Without the Use of Mesh

Abraham Betancourt, MD, Abraham Abdemur, MD, Armando Rosales-Velderrain, MD, Emanuele LoMenzo, MD, FACS, Samuel Szomstein, MD, FACS, Raul J Rosenthal, MD, FACS. Cleveland Clinic Florida

Introduction: Closure of diaphragmatic Hiatal defects is one of the most demanding procedures performed laparascopically with a reported high recurrence rate. Mesh reinforcement in combination with non-absorbable suture has been proposed in order to solve this problem.

Methods: Between 2010 and 2012, patients who underwent laparoscopic hiatal hernia repair were retrospectively reviewed. Patients were assessed with office visits and by telephone with the gastroesophageal reflux disease-health related quality of life scale (GERD-HRQL).

Results: Sixty-four patients underwent laparoscopic hiatal hernia repair over a 2 years period. In 34 patients the hiatal closure was performed using unidirectional non-absorbable barbed suture alone, while in 30 patients the hiatal closure was obtained with the aid of non- absorbable barbed suture and reinforced with mesh. Type I, II, III and IV hernia was identified, 17, 21, 20 and 6 patients respectively. Nissen fundoplication was used as antireflux procedure in 96.88% of the patients. Operative time was 68.13±12.74 min (mean ± SD) in the non-absorbable barbed suture group vs. 90.7± 20.76 min in non-absorbable barbed suture reinforced with mesh (p= 0.0007). Twenty-six patients out of 64 (40.6%) were assessed by telephone with the GERD-HRQL. Twenty-five reported been satisfied with their condition after surgery. Two patients in the barbed suture plus mesh group presented long-term dysphagia both been treated conservatively. No recurrences were noted in either groups.

Conclusion: Closure of the Hiatal hernia with running Quills suture is feasible and enhances patient safety, operative time, as well as technical considerations.