title: Onlay hiatal reinforcement utilizing human acellular dermal matrix: three case series.
abstract: Redo laparoscopic fundoplication and laparoscopic repair of large (>5cm) paraesophageal hernias have a high rate of recurrence after primary suture repair of the hiatal defect. As such, the use of mesh prosthesis as an interposition graft or onlay reinforcement is becoming more popular for the repair of larger, more complicated crural defects. We report three cases in which human acellular dermal matrix was used as an onlay reinforcement of the hiatus after primary suture closure. Two patients had large paraesophageal hernias (one type III and one type IV). The third patient became symptomatic after her second laparoscopic antireflux procedure and was found to have recurrent herniation of the fundus into the mediastinum. All three patients underwent successful laparoscopic repair. There were no intraoperative or postoperative complications. All three patients remain symptom free with follow-up ranging from 8 months to 10 months. Acellular dermal matrix appears to be a promising prosthetic for onlay reinforcement of the hiatus during redo laparoscopic fundoplication and repair of large paraesophageal hernias.
authors.affiliation: Department of General Surgery, William Beaumont Army Medical Center, El Paso, TX 79920-5001, and Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA. jason.johnson35@us.army.mil
authors.forename: Jason M
authors.initials: JM
authors.lastname: Johnson
authors.forename: Brennan J
authors.initials: BJ
authors.lastname: Carmody
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Jamal
authors.forename: Eric J
authors.initials: EJ
authors.lastname: DeMaria
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020405:Dermis / Q000166:cytology / Q000637:transplantation; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013718:Tensile Strength; D016896:Treatment Outcome