A simplified technique for intrathoracic stomach repair: laparoscopic fundoplication with Vicryl mesh and BioGlue crural reinforcement.
BACKGROUND
Laparoscopic repair of an intrathoracic stomach has been associated with a high recurrence rate. The use of biologic or synthetic mesh to reinforce the crural repair has been shown to reduce recurrence. This study aimed to assess a simplified technique for reinforcing the crural repair using absorbable Vicryl mesh secured with BioGlue during laparoscopic repair of an intrathoracic stomach.


METHODS
The charts of all patients who underwent laparoscopic repair of an intrathoracic stomach from June 2006 to March 2009 using the described technique were retrospectively reviewed. Intrathoracic stomach was defined as more than 50% of the stomach herniated into the chest. Follow-up assessment was routinely performed 1 year or more after surgery and included endoscopy, video esophagram, Bravo 48-h pH monitoring, and a gastroesophageal reflux disease (GERD)-health-related quality-of-life (HRQL) questionnaire.


RESULTS
A total of 35 patients (male:female = 10:25) with a mean age of 70 years (48-89 years) and a mean body mass index (BMI) of 30.4 kg/m(2) (20.4-44.8 kg/m(2)) underwent repair using this technique. The median operating time was 144 min (101-311 min), and the median hospital stay was 2 days (1-21 days). There were three conversions (8.6%) and one intraoperative complication (2.9%). Three patients (8.6%) experienced postoperative complications. No mesh-related complications occurred. Follow-up assessment 1 year or more after surgery was available for 21 of the 25 eligible patients [median follow-up period, 14 months (11-34 months)]. There were two recurrences (9.5%), one of them asymptomatic. The median GERD-HRQL score was 5 (2-28). Nearly all the patients (91.3%) were satisfied with the operation, and 96% would have it again.


CONCLUSIONS
Vicryl mesh secured with BioGlue is a simple and easy method for reinforcing the crural closure during laparoscopic repair of an intrathoracic stomach. The recurrence rate at 1 year is low and comparable with that of other series using biologic mesh secured with sutures or tacks.
Zehetner
Jörg
J
Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA.
Lipham
John C
JC
Ayazi
Shahin
S
Oezcelik
Arzu
A
Abate
Emmanuele
E
Chen
Weisheng
W
Demeester
Steven R
SR
Sohn
Helen J
HJ
Banki
Farzaneh
F
Hagen
Jeffrey A
JA
Dickey
Melissa
M
Demeester
Tom R
TR
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011098:Polyglactin 910; D011183:Postoperative Complications; D011506:Proteins; D011788:Quality of Life; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
C472676:Bio-glue; D011506:Proteins; D011098:Polyglactin 910
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