Reinforcement of hiatal defect repair with absorbable mesh fixed with non-permanent devices.
OBJECTIVE
To report the results of an open label prospective study on a new technique for laparoscopic hiatal hernia (HH) repair with absorbable mesh fixed with absorbable materials Methods: From January 2011 to May 2013, 43 patients were treated; group A, 20 patients submitted to laparoscopic sleeve gastrectomy (LSG); group B, 13 patients submitted to revisional surgery for the diagnosis of HH and symptomatic GERD post-LSG; and group C, ten patients submitted to 360° fundoplication. All patients underwent cruroplasty reinforced with bio-absorbable mesh fixed with absorbable tacks and/or fibrin glue. Conversion rate, intra-operative complications, operative time (tacks vs tacks plus fibrin glue), perioperative complications, perioperative symptoms and radiological control set the criteria for clinical/surgical evaluation.


RESULTS
Conversion and mortality rate was 0%. The mean time for mesh fixation with the tacks vs tacks plus fibrin glue was 6.2 ± 2 vs 7.3 ± 3 min. The remission of GERD symptoms was observed in 39 patients, and we did not observe any cases of mesh-related complications at a mean follow-up of 17.4 months. Recurrence rate was 2.3% (one asymptomatic patient of group B).


CONCLUSIONS
Reinforcement with absorbable mesh-cancel bio mesh is a safe and effective option for laparoscopic HH repair in normal weight and obese patients.
Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery & Bariatric Center of Excellence, University of Rome , Latina , Italy.
Gianfranco
G
Silecchia
Angelo
A
Iossa
Giuseppe
G
Cavallaro
Mario
M
Rizzello
Fabio
F
Longo
D000328:Adult; D005260:Female; D015718:Fibrin Tissue Adhesive; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D013526:Surgical Mesh; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive
Hiatal hernia; absorbable fixation; bio-absorbable mesh; laparoscopy; morbid obesity