Morris E Franklin, MD, FACS, Rene Palomo, Guillermo Portillo, MD, Eduardo Perez,, MD, Alexander Richard, MD, Karla Russek, MD, Alejandro Rodriguez, MD, Z Del Real, G Peralta, md. texas endosurgery institute,San Antonio, Texas..
A variety of randomized studies have demonstrated the advantages of using prosthesis in the repair of a hiatal hernia. Recurrence rates drop dramatically at first in the short terms when a mesh is applied. However there is still controversy regarding what prosthesis should be used and how to place it, as well as long term results.
From January 2001 to April 2010, all patients having hiatal hernia, and gastroesophageal reflux, underwent laparoscopic hiatal hernia repair with porcine bowel derived mesh placement were prospectively studied. Indications for the use of prosthetic material initially included: Recurrent hiatal hernia, crus defect > 5 cm, obesity, chronic pulmonary disease, impaired healing (steroids use, >80 years old), and incarcerated hernia, but more recently all patients undergoing hiatal hernia repair were included on the study.
One hundred and thirty two patients were analyzed, 49% of patients were female and 51% male; the mean age was 60.1 years (32-91 years).
Mean operating time was 167 minutes with a range of 75-273 minutes. EBL was 28 ml (50-100 ml). One third of patients (34%) had extensive adhesions present within the hiatal hernia. One patient required conversion secondary to these adhesions. All the patients had a follow up of 6 months, 91% of 1 year, 83% of 2 years, 65% of 3 years 52% of 4 years and more than 5 years 39%. Recurrence was seen in only one patient (0.9%). There were no complications related to prostheses placement. The mortality rate was 0%.
Laparoscopic placement of porcine’s small bowel submucosa in the hiatus, at the time of laparoscopic repair, is a safe and effective measure to prevent recurrence of hiatal hernia.