title: Crura augmentation with Bio-A®mesh for laparoscopic repair of hiatal hernia: single-institution experience with 100 consecutive patients.
abstract: The potential utility of both non-absorbable and absorbable meshes to reinforce the esophageal hiatus and prevent recurrent hernia has been investigated in observational studies and a few randomized clinical trials. Use of absorbable mesh has been associated with lesser side-effects, but the long-term safety and effectiveness are still debated. This rather scanty clinical evidence is due to heterogeneity and bias regarding the type of mesh and operation used, the modalities of follow-up, and the reporting of objective results.
  
  
  
  The aim of the study was to assess safety, quality of life, and recurrence-free probability after laparoscopic repair of hiatal hernia reinforced with a synthetic absorbable mesh.
  
  
  
  Observational, retrospective, single-center cohort study. All patients with hiatal hernia who underwent laparoscopic crura repair using a biosynthetic mesh (Gore Bio A®tissue reinforcement, Flagstaff, AZ) were included. Pre- and post-operative symptoms were assessed with the GERD-HRQL questionnaire. Objective follow-up consisted of upper gastrointestinal endoscopy and barium swallow study.
  
  
  
  From September 2011 to March 2016, a total of 100 patients underwent hiatal hernia repair using a Bio-A®mesh. All surgical procedures were completed laparoscopically. Postoperative morbidity rate was 10%. All patients had a minimum follow-up of 6 months, and the median follow-up was 30 (IQR = 22) months. No mesh-related complications occurred. The incidence of recurrent hernia ≥2 cm was 9%, and eight of the nine patients had a preoperative type III hernia. The median GERD-HRQL score was significantly reduced after operation (p < 0.001). The recurrence-free probability at 1 and 5 years was, respectively, 0.99 (CI 0.97-1.00) and 0.84 (CI 0.74-0.97), and no reoperation was required. No association was found between age, BMI, hernia size, previously failed surgical repairs and hernia recurrence.
  
  
  
  The use of a synthetic absorbable mesh to reinforce the esophageal hiatus is safe and appears to be effective and durable over a medium-term follow-up.
authors.affiliation: Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milano Medical School, Piazza Malan 1, San Donato Milanese, 20097, Milano, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Asti
authors.affiliation: Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milano Medical School, Piazza Malan 1, San Donato Milanese, 20097, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sironi
authors.affiliation: Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milano Medical School, Piazza Malan 1, San Donato Milanese, 20097, Milano, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bonitta
authors.affiliation: Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milano Medical School, Piazza Malan 1, San Donato Milanese, 20097, Milano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lovece
authors.affiliation: Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milano Medical School, Piazza Malan 1, San Donato Milanese, 20097, Milano, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Milito
authors.affiliation: Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milano Medical School, Piazza Malan 1, San Donato Milanese, 20097, Milano, Italy. luigi.bonavina@unimi.it.
authors.forename: L
authors.identifier: 0000-0002-4880-1670
authors.initials: L
authors.lastname: Bonavina
mesh_terms: D020341:Absorbable Implants; D000368:Aged; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation* / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D019736:Prostheses and Implants; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D011795:Surveys and Questionnaires
keywords: Fundoplication; Hiatus hernia; Laparoscopic hiatus hernia repair; Recurrent hernia