Recurrence rate of PEHs at 1 yr: Synthetic vs biologic mesh

Maria C Michael, MA, MD, Edward Borrazzo, MD

Fletcher Allen Health Care

This retrospective study examines the recurrence rates of paraesophageal hernias repaired with synthetic mesh (Crurasoft, Bard) and biologic mesh (Alloderm, Lifecell) at one year follow up. Paraesophageal hernias are uncommon but have potentially high risks of morbidity and mortality from gastric volvulus and incarceration if left uncorrected. The introduction of synthetic and biologic mesh into the procedure have each been shown to reduce the incidence of recurrence and subsequent reoperation in comparison to primary crural repair (Granderath et al, 2005 & Oeschlager et al, 2006). However, synthetic and biologic mesh products have not yet been compared directly.

A total of 124 patients underwent laparoscopic paraesophageal hernia repair at FAHC from 2002- 2011, and 93 patients had one year follow up including 23 with synthetic mesh and 70 with biologic mesh. Recurrence was assessed using barium esophagram at one year post-procedure. Statistical analysis was performed using Pearson’s Chi Square test, Fischer exact test, and two sided T-test.

Radiographic recurrence with biologic mesh and synthetic mesh was 21% (15/70) and 13%(3/23) (p= 0.3), respectively, with an overall recurrence rate of 18%. Symptomatic recurrences, complaints beyond mild dysphagia and bloating attributable to the antireflux procedure, were much less at 10% (7/70) and 4% (1/23) respectively. Gender, age, BMI, and the type of wrap did not have a statistically signifcant impact on recurrence for repairs with sythetic or biologic mesh.

While the sample size prevents definitive conclusions about the superiority of synthetic or biologic mesh, these observations of patient outcomes give support to the claims that synthetic and biologic mesh are at least equally successful in primary paraesophageal hernia repair.

Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg. 2005 Jan;140(1):40-8. PubMed PMID: 15655204.

Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg. 2006 Oct;244(4):481-90. PubMed PMID: 16998356; PubMed Central PMCID: PMC1856552.

Session: Podium Presentation

Program Number: S020

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