Safety and effectiveness of the use of polypropylene mesh to reinforce the hiatus during laparoscopic fundoplication

Eduardo N Trindade, MD, Manoel R Trindade, MD, Vinicius von Diemen, MD, Ricardo F Francio

Department of Surgery, Universidade Federal do Rio Grande do Sul (UFRGS) and Division of Digestive Surgery, Hospital de Clinicas de Porto Alegre (HCPA)

INTRODUCTION: We want to demonstrate the safety and effectiveness of the use of polypropylene mesh as a routine conduct to reinforce the hiatal hernioplasty in the surgical treatment of gastroesofagical reflux disease (GERD) and hiatal hernia (HH), analyzing the success’s index and the rate of complications of this surgical technique.

METHODS AND PROCEDURES: Prospective analysis of a case series from october, 2006 to september, 2012, of all patients submitted to total 3600 laparoscopic fundoplication (Nissen) with reinforce of polypropylene mesh (variable sizes) with search of comparative data in the literature. The variables analyzed were: gender, age, diagnostic, hernia type, preoperative exams, length of hospital, major symptoms before and after surgery, and complications regarding to the long-term use of polypropylene mesh. The analyses were performed using the exact binomial test, and the data were recorded in an Excel database for Windows. The project was approved by the ethics committee and all patients signed written statement of informed consent.

RESULTS: Were followed up postoperatively 48 patients, with an average time of 35.4 months (1-70). Preoperatively, 87.2% were diagnosed with GERD and HH, 10.6% with exclusive diagnosis of HH, and 2.1% (1 case) with only GERD (n=47). Related to the hernia type, 38 patients presented sliding hiatal hernia, and 4 parahiatal hernia (n=42). There were 32 women and 16 men, with average age of 53 years old (24-84) (n=48). Only one patient did not manifest pyrosis, and only 6 patients did not demonstrate pathological reflux in the 24 hours esophageal pHmetry because they were in use of protons bomb inhibitor. 79,5% presented dysphasia (n=39). 69.7% of all cases presented dysmotility in the manometry. All meshes were sutured with stitches of polidaxone sheet 2-0. The average surgical time was 132 minutes (65-240) and length of hospital, 3,92 days (2-20). During the follow up, no complications due to the use of polypropylene mesh occurred in any of the patients, and was achieved complete resolution of the pyrosis for all patients (p<0,001, with 95% CI: 0.84-0.99). Only 4 presented sporadic dysphagia for solids after 24 months of surgery, and there was only one case of hiatal recurrence after 11 months of surgery.

CONCLUSION: In our report, we conclude that the enhancement of hiatal hernia with prosthesis use, after average postoperative follow up of 35.4 months, show no complications and the resolution of symptoms was similar to literature. Therefore, the use of polypropylene mesh is not an exceptional handling anymore, but a therapeutic option in most cases, since the recurrence, both anatomical and physiological, significantly decreases, avoiding the need for further surgery.

Session: Poster Presentation

Program Number: P615

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