Pei-Wen Lim, MD, Stephanie Bond, MS, Nicole Cherng, MD, John J Kelly, MD. University of Massachusetts Medical School
Background: Laparoscopic hiatal hernia repair, particularly large type 1 and type 3 hernias, is associated with high recurrence rates. Various use of overlay mesh reinforcement have been described in an attempt to improve outcomes. Unfortunately, overlay use of biologic mesh continues to result in high recurrence rates, and more effective repairs employing permanent mesh raise serious erosion concerns and are therefore rarely used. We theorize that employing an interlay technique with permanent mesh (positioned between both crura) will help enhance crural closure and improve rates of hiatal hernia recurrences with minimal risk of erosion.
Methods: We reviewed all patients who underwent a laparoscopic hiatal hernia repair from April 2015 to August 2017 by a single surgeon from a prospectively maintained database at a tertiary care referral center (n= 72). Patients who underwent surgery for achalasia with concurrent hiatal repair were excluded. During this time frame, a new interlay technique of polypropylene mesh was employed upon suture closure of the crura. Outcomes of repair were retrospectively reviewed. Recurrence of hernia was identified by positive work up of patient’s symptoms (new onset dysphagia, GERD, pain).
Results: A total of 72 consecutive laparoscopic hiatal hernia repair were reported in a period of 28 months. Interlay polypropylene mesh was utilized in all repairs. Patients were majority females (74.0%), had a median age of 61 and had a mean BMI of 31.3. Eleven (15.0%) patients were redo repairs. Majority of patients received a Nissen fundoplication (n=54, 75.0%) followed by a toupet fundoplication (n=14, 19.4%). Median length of stay after surgery was 1 day. Median follow up was 43 days (range: 11 – 659 days). There were zero reported recurrences.
Conclusion: Laparoscopic hiatal hernia repair with interlay polypropylene mesh appears in the short term to be a safe and durable technique to reduce the incidence of hiatal hernia recurrences. Further studies are needed to assess more long term outcomes of this novel technique.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86614
Program Number: P434
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster