title: Hiatal Hernia Repair with Novel Biological Graft Reinforcement.
abstract: OBJECTIVE
  Hiatal hernias are repaired laparoscopically with increasing use of reinforcement material. Both synthetic and biologically derived materials reduce the recurrence rate compared to primary crural repair. Synthetic mesh introduces complications, such as mesh erosion, fibrosis, and infection. Urinary bladder matrix (UBM) represents a biologically derived material for use in hiatal hernia repair reinforcement with the potential to improve durability of repair without incurring the risks of other reinforcement materials.
  
  
  METHODS
  The 15 cases presented involved hiatal hernia repair with primary crural repair with UBM reinforcement and fundoplication. Patients were followed for an average of 3 years, and were assessed with upper gastrointestinal (GI) series, endoscopy, and assessments of subjective symptoms of gastroesophageal reflux disease (GERD).
  
  
  RESULTS
  Hernia diameters averaged 6 cm. Each repair was successful and completed laparoscopically. UBM exhibited favorable handling characteristics when placed as a horseshoe-type graft sutured to the crura. One patient underwent endoscopic balloon dilatation of a mild postoperative stenosis that resolved. No other complications occurred. In more than 3 years of follow-up, there have been no recurrences or long-term complications. GERD-health-related quality of life (HRQL) scores averaged 6 (range, 0-12, of a possible 50), indicating little reflux symptomatology. Follow-up upper GI series were obtained in 9 cases and showed intact repairs. An upper endoscopy was performed in 8 patients and showed no recurrences.
  
  
  CONCLUSIONS
  Surgeons may safely use laparoscopic fundoplication with UBM reinforcement for successful repair of hiatal hernias. In this series, repairs with UBM grafts have been durable at 3 years of follow-up and may serve as an alternative to synthetic mesh reinforcement of hiatal hernia repairs.
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Kent C
authors.initials: KC
authors.lastname: Sasse
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Warner
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Ackerman
authors.affiliation: University of Nevada School of Medicine, Reno, Nevada, USA.
authors.forename: Jared
authors.initials: J
authors.lastname: Brandt
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012008:Recurrence; D013526:Surgical Mesh
keywords: Hiatal hernia; Upper GI surgery; Urinary bladder matrix