A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia.
OBJECTIVE
Large hiatal hernias are prone to disruption, resulting in reherniation, when repaired with simple cruroplasty. The use of mesh may decrease the rate of reherniation in the laparoscopic repair of large hiatal hernias.


METHODS
Prospective, randomized controlled trial.


METHODS
University-affiliated private hospital.


METHODS
Seventy-two individuals undergoing laparoscopic Nissen fundoplication with a hernia defect greater or equal to 8 cm in diameter.


METHODS
Nissen fundoplication with posterior cruroplasty (n = 36) vs Nissen fundoplication with posterior cruroplasty and onlay of polytetrafluoroethylene (PTFE) mesh (n = 36).


METHODS
Recurrences, complications, hospital stay, operative time, and cost.


RESULTS
Patients in both groups had similar hospital stays, but the PTFE group had a longer operative time. The cost of the repair was $960 +/- $70 more in the group with the prosthesis. Complications were minor and similar in both groups. There were 8 hernia recurrences (22%) in the primary repair group and none in the PTFE group (P<.006).


CONCLUSIONS
The use of prosthetic reinforcement of cruroplasty in large hiatal hernias may prevent hernia recurrences.
Frantzides
Constantine T
CT
Department of Surgery, Rush University, Chicago, IL, USA. Constantine_T_Frantzides@rush.edu
Madan
Atul K
AK
Carlson
Mark A
MA
Stavropoulos
George P
GP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018662:Fundoplication; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D011446:Prospective Studies; D019736:Prostheses and Implants; D055502:Secondary Prevention; D013526:Surgical Mesh
D011138:Polytetrafluoroethylene