title: Effect of acellular human dermis buttress on laparoscopic hiatal hernia repair.
abstract: OBJECTIVE
  The objective of this study was to evaluate the performance of acellular human dermis reinforcement during laparoscopic hiatal hernia repair.
  
  
  METHODS
  A prospective non-randomized, single institution study enrolled patients undergoing laparoscopic hiatal hernia repair. Acellular human dermis, FlexHD (Musculoskeletal Transplant Foundation, Edison, NJ) or AlloDerm (LifeCell Inc., Branchburg, NJ) were used to buttress the repair after primary closure. A protocol barium swallow (BAS) was performed at 6 months and then as needed due to clinical indications. Primary outcome measure was recurrence. Patients completed preoperative and postoperative GERD symptom questionnaires and quality of life surveys (SF-36). Kruskal-Wallis ANOVA, Student's t test, Fisher's exact test, or Wilcoxon signed-rank test were utilized as appropriate (p < 0.05 considered statistically significant).
  
  
  RESULTS
  Fifty-four patients (10 men and 44 women) with a mean age of 62 ± 10 years underwent laparoscopic hiatal hernia repair using Flex HD (n = 37) or AlloDerm (n = 17). Both groups were similar with respect to gender, age, hiatus size, hernia type [sliding/Type I (n = 14) or paraesophageal/Type III/IV (n = 40)], esophageal motor function (manometry), preoperative SF-36 quality of life surveys, and GERD symptom questionnaires. Forty-seven patients (87 %) completed the BAS at 6 months; each group had two recurrences (p = 0.597). At median follow-up of 33 months, there were 3 recurrences (18 %) in the AlloDerm group and 5 recurrences (14 %) in the Flex HD group (p = 0.365). Minimal differences in GERD symptoms or SF-36 scores were detected between groups. However, anti-reflux medication usage, GERD symptoms, and quality of life significantly improved for both groups after laparoscopic hiatal hernia repair.
  
  
  CONCLUSIONS
  Laparoscopic hiatal hernia repair with acellular human dermis reinforcement results in improvement of GERD-related symptoms and quality of life without mesh-associated complications. The type of acellular human dermis did not influence recurrence rate.
authors.affiliation: William Beaumont Army Medical Center, El Paso, TX, USA.
authors.forename: Kyle C
authors.initials: KC
authors.lastname: Ward
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Costello
authors.forename: Sara
authors.initials: S
authors.lastname: Baalman
authors.forename: Richard A
authors.initials: RA
authors.lastname: Pierce
authors.forename: Corey R
authors.initials: CR
authors.lastname: Deeken
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Frisella
authors.forename: L
authors.initials: L
authors.lastname: Michael Brunt
authors.forename: Brent D
authors.initials: BD
authors.lastname: Matthews
mesh_terms: D062088:Acellular Dermis; D003094:Collagen; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation
chemical_list: C440568:Alloderm; D003094:Collagen