title: Histologic results 1 year after bioprosthetic repair of paraesophageal hernia in a canine model.
abstract: BACKGROUND
  The use of prosthetic materials for the repair of paraesophageal hiatal hernia (PEH) may lead to esophageal stricture and perforation. High recurrence rates after primary repair have led surgeons to explore other options, including various bioprostheses. However, the long-term effects of these newer materials when placed at the esophageal hiatus are unknown. This study assessed the anatomic and histologic characteristics 1 year after PEH repair using a U-shaped configuration of commercially available small intestinal submucosa (SIS) mesh in a canine model.
  
  
  METHODS
  Six dogs underwent laparoscopic PEH repair with SIS mesh 4 weeks after thoracoscopic creation of PEH. When the six dogs were sacrificed 12 months later, endoscopy and barium x-ray were performed, and biopsies of the esophagus and crura were obtained.
  
  
  RESULTS
  The mean weight of the dogs 1 year after surgery was identical to their entry weight. No dog had gross dysphagia, evidence of esophageal stricture, or reherniation. At sacrifice, the biomaterial was not identifiable grossly. Biopsies of the hiatal region showed fibrosis as well as muscle fiber proliferation and regeneration. No dog had erosion of the mesh into the esophagus.
  
  
  CONCLUSIONS
  This reproducible canine model of PEH formation and repair did not result in erosion of SIS mesh into the esophagus or in stricture formation. Native muscle ingrowth was noted 1 year after placement of the biomaterial. According to the findings, SIS may provide a scaffold for ingrowth of crural muscle and a durable repair of PEH over the long term.
authors.affiliation: Department of Surgery and Institute for Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Desai
authors.forename: S
authors.initials: S
authors.lastname: Diaz
authors.forename: I G
authors.initials: IG
authors.lastname: Dorward
authors.forename: E R
authors.initials: ER
authors.lastname: Winslow
authors.forename: M C
authors.initials: MC
authors.lastname: La Regina
authors.forename: V
authors.initials: V
authors.lastname: Halpin
authors.forename: N J
authors.initials: NJ
authors.lastname: Soper
mesh_terms: D000818:Animals; D001672:Biocompatible Materials; D013505:Digestive System Surgical Procedures; D004195:Disease Models, Animal; D004285:Dogs; D006551:Hernia, Hiatal / Q000473:pathology* / Q000601:surgery*; D007413:Intestinal Mucosa / Q000637:transplantation; D007421:Intestine, Small / Q000637:transplantation*; D014945:Wound Healing
chemical_list: D001672:Biocompatible Materials