Preliminary study of hiatal hernia repair using polyglycolic acid: trimethylene carbonate mesh.
BACKGROUND
Repairing large hiatal hernias using mesh has been shown to reduce recurrence. Drawbacks to mesh include added time to place and secure the prosthesis as well as complications such as esophageal erosion. We used a laparoscopic technique for repair of hiatal hernias  (HH) >5cm, incorporating primary crural repair with onlay fixation of a synthetic polyglycolicacid:trimethylene carbonate (PGA:TMC) absorbable tissue reinforcement. The purpose of this report is to present short-term follow-up data.


METHODS
Patients with hiatal hernia types I-III  and defects >5cm were included. Primary closure of the hernia defect was performed using interrupted nonpledgeted sutures, followed by PGA:TMC mesh onlay fixed with absorbable tacks. A fundoplication was then performed. Evaluation of patients was carried out at routine follow-up visits. Outcomes  measured were symptoms of gastroesophageal reflux disease (GERD), or other symptoms suspicious for recurrence. Patients exhibiting these complaints underwent further evaluation including radiographic imaging and endoscopy.


RESULTS
Follow-up data were analyzed on 11 patients. Two  patients were male; 9 were female. The mean age was 60 years. The mean length of follow-up was 13 months. There were no complications related to the mesh. One patient suffered from respiratory failure, one from gas bloat syndrome, and another had a superficial port-site infection. One patient  developed a recurrent hiatal hernia.


CONCLUSIONS
In this small series, laparoscopic repair of hiatal hernias >5cm with onlay fixation of PGA:TMC tissue reinforcement has short-term outcomes with a reasonably low recurrence rate. However, due to the preliminary and nonrandomized  nature of the data, no strong comparison can be made with other types of mesh repairs. Additional data collection is warranted.
Department of General Surgery, Albany Medical Center, Albany, NY, USA. jmdm34@gmail.com
James M
JM
Massullo
Tejinder P
TP
Singh
Ward J
WJ
Dunnican
Brian R
BR
Binetti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004146:Dioxanes / Q000627:therapeutic use; D004867:Equipment Design; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011100:Polyglycolic Acid / Q000627:therapeutic use; D013526:Surgical Mesh; D016896:Treatment Outcome
D004146:Dioxanes; D011100:Polyglycolic Acid; C443643:trimethylene carbonate