Biologic Prosthesis to Prevent Recurrence after Laparoscopic Paraesophageal Hernia Repair: Long-term Follow-up from a Multicenter, Prospective, Randomized Trial
Top Cited Papers
- 29 June 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 213 (4), 461-468
- https://doi.org/10.1016/j.jamcollsurg.2011.05.017
Abstract
Background In 2006, we reported results of a randomized trial of laparoscopic paraesophageal hernia repair (LPEHR), comparing primary diaphragm repair (PR) with primary repair buttressed with a biologic prosthesis (small intestinal submucosa [SIS]). The primary endpoint, radiologic hiatal hernia (HH) recurrence, was higher with PR (24%) than with SIS buttressed repair (9%) after 6 months. The second phase of this trial was designed to determine the long-term durability of biologic mesh-buttressed repair. Methods We systematically searched for the 108 patients in phase I of this study to assess current clinical symptoms, quality of life (QOL) and determine ongoing durability of the repair by obtaining a follow-up upper gastrointestinal series (UGI) read by 2 radiologists blinded to treatment received. HH recurrence was defined as the greatest measured vertical height of stomach being at least 2 cm above the diaphragm. Results At median follow-up of 58 months (range 42 to 78 mo), 10 patients had died, 26 patients were not found, 72 completed clinical follow-up (PR, n = 39; SIS, n = 33), and 60 repeated a UGI (PR, n = 34; SIS, n = 26). There were 20 patients (59%) with recurrent HH in the PR group and 14 patients (54%) with recurrent HH in the SIS group (p = 0.7). There was no statistically significant difference in relevant symptoms or QOL between patients undergoing PR and SIS buttressed repair. There were no strictures, erosions, dysphagia, or other complications related to the use of SIS mesh. Conclusions LPEHR results in long and durable relief of symptoms and improvement in QOL with PR or SIS. There does not appear to be a higher rate of complications or side effects with biologic mesh, but its benefit in reducing HH recurrence diminishes at long-term follow-up (more than 5 years postoperatively) or earlier.Keywords
This publication has 11 references indexed in Scilit:
- Hiatal Hernia Recurrence: Surgical Complication or Disease? Electron Microscope Findings of the Diaphragmatic PillarsJournal of Gastrointestinal Surgery, 2009
- Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case seriesSurgical Endoscopy, 2008
- Elastic Fiber Depletion in the Supporting Ligaments of the Gastroesophageal Junction: A Structural Basis for the Development of Hiatal HerniaJournal of the American College of Surgeons, 2008
- Complications of PTFE Mesh at the Diaphragmatic HiatusJournal of Gastrointestinal Surgery, 2008
- Laparoscopic repair of large hiatal herniasBritish Journal of Surgery, 2005
- Laparoscopic Nissen Fundoplication With Prosthetic Hiatal Closure Reduces Postoperative Intrathoracic Wrap HerniationArchives of Surgery, 2005
- A Prospective, Randomized Trial of Laparoscopic Polytetrafluoroethylene (PTFE) Patch Repair vs Simple Cruroplasty for Large Hiatal HerniaArchives of Surgery, 2002
- Long-term outcome of laparoscopic repair of paraesophageal herniaSurgical Endoscopy, 2002
- Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate1Journal of the American College of Surgeons, 2000
- Paraesophageal herniation as a complication following laparascopic antireflux surgeryJournal of Gastrointestinal Surgery, 1999