Walaa F Abdelmoaty, MD, MBA1, Christy M Dunst, MD, FACS2, Filippo Filicori, MD1, Ahmed M Zihni, MD, MPH1, Daniel Davila Bradley, MD2, Kevin M Reavis, MD, FACS2, Lee L Swanstrom, MD, FACS2, Steven R DeMeester, MD, FACS2. 1Providence Portland Medical Center, 2The Oregon Clinic
Introduction: Mesh use for reinforcement of primary crural closure is controversial. Synthetic mesh use poses a risk of erosion but there is no evidence that non-synthetic mesh is useful to minimize the risk of hernia recurrence. We evaluated a fully bioresorbable mesh made from poly-4-hydroxybutyrate (P4HB) for crural reinforcement after para-esophageal hernia (PEH) repair. The aim of this study was to evaluate the safety and efficacy of P4HB mesh at the hiatus in patients undergoing PEH repair.
Methods and procedures: This was a review of prospectively collected data on 50 consecutive patients that had repair of a PEH with reinforcement of the crural closure with P4HB mesh. To be considered a PEH at least 50% of the stomach was herniated into the chest. A Collis gastroplasty or crural relaxing incision was added for short esophagus or crural tension when necessary. Routine follow-up consisted of Esophagogastroduodenoscopy (EGD) at 3 months for patients that had a Collis gastroplasty and a barium upper GI study (UGI), high resolution manometry (HRM) and pH test in all patients at 12 months. A hernia of any size identified during objective follow-up testing was considered a recurrence.
Results: There were 50 patients (34 females and 16 Males) with a mean age of 65 years (98-30), and mean BMI of 30.24 (41.5-17.7). The median ASA was 2, mean operative time was 150 minutes, mean estimated blood loss was 103 ml and mean length of stay was 2.8 days. The majority of repairs were primary (88%) Two procedures (4%) were converted to open. A fundoplication was added to PEH repair in 49 patients (98%) while 1 patient underwent a partial gastrectomy. Collis gastroplasty was performed in 18 patients (36%) and a right relaxing incision in 2 patients (4%). The median follow-up was 8.5 months and 12 patients had their PEH repair at least 1 year ago. Objective testing at 3 months with EGD or UGI in 17 patients and at 1 year with UGI in 3 patients has shown only 1 recurrent hernia. There were no mesh-related complications or erosions.
Conclusions: PEH repair with bioresorbable P4HB mesh crural reinforcement and appropriate tension-reducing techniques when indicated is associated with a low early hernia recurrence rate and no mesh-related complications. Further studies with this mesh are indicated to confirm long-term efficacy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87606
Program Number: P400
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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