1
|
A Surgical Alternative in the Treatment of Recurrent Diaphragmatic Hernia after Total Gastrectomy. Plast Reconstr Surg Glob Open 2020; 8:e3302. [PMID: 33425611 PMCID: PMC7787302 DOI: 10.1097/gox.0000000000003302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/21/2020] [Indexed: 11/26/2022]
Abstract
Treament of hiatal hernia remains a challenge for surgeons. The techniques for treatment started with cruroplasty, which was later associated with extensive mobilization of the esophagus, with or without fundoplication. Other solutions included the use of synthetic or biological mesh and autologous tissue reinforcement. Despite these therapeutic strategies, the recurrence rate for hiatal hernia is significant, and no existing treatments have had much success in reducing this rate. Total gastrectomy, as in this case, represents an additional challenge because of the absence of gastric tissue, which can buttress the pillars’ repair. This case report introduces a novel approach for the treatment of recurrent hiatal hernia, using a pedicled vertical rectus abdominis myocutaneous flap.
Collapse
|
2
|
Mesh-related complications in paraoesophageal repair: a systematic review. Surg Endosc 2020; 34:4257-4280. [PMID: 32556700 DOI: 10.1007/s00464-020-07723-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/09/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND Paraoesophageal hernias (PEH) have a high recurrence rate, prompting surgeons to consider the use of mesh reinforcement of the hiatus. The risks and benefits of mesh augmentation in PEH repair are debated. Mesh-related complications including migration and erosion are considered in this publication. DESIGN A systematic literature review of articles published between 1970 and 2019 in Medline, OVID, Embase, and Springer database was conducted, identifying case reports, case series and observational studies of PEH repair reporting mesh-related complications. RESULTS Thirty-five case reports/series of 74 patients and 20 observational studies reporting 75 of 4200 patients with mesh complications have been included. The incidence of mesh-related erosions in this study is 0.035%. PTFE, ePTFE, composite and synthetic meshes were frequently associated with mesh erosion requiring intervention. Complete erosions are often managed endoscopically while partial erosions may require surgery and resection of the oesophagus and/or stomach. CONCLUSIONS Mesh-related complication is rare with dysphagia a common presenting feature. Mesh erosion is associated with synthetic mesh more frequently in the reported literature. A mesh registry with long-term longitudinal data would help in understanding the true incidence of mesh-related complications.
Collapse
|
3
|
Khaled I, Priego P, Faisal M, Cuadrado M, García-Moreno F, Ballestero A, Galindo J, Lobo E. Assessment of short-term outcome with TiO 2 mesh in laparoscopic repair of large paraesophageal hiatal hernias. BMC Surg 2019; 19:156. [PMID: 31660930 PMCID: PMC6816156 DOI: 10.1186/s12893-019-0607-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 09/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background Laparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™). Methods A retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks. Results Twenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred. Conclusions TiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.
Collapse
Affiliation(s)
- Islam Khaled
- Department of Surgery, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Pablo Priego
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain.
| | - Mohammed Faisal
- Department of Surgery, Suez Canal University Hospitals and Medical School, Ismailia, Egypt
| | - Marta Cuadrado
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Francisca García-Moreno
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Araceli Ballestero
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Julio Galindo
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| | - Eduardo Lobo
- Division of Esophagogastric, Bariatric and Minimally Invasive Surgery, Department of Surgery, Ramon y Cajal University Hospital, Crta. Colmenar Viejo Km 9,100, 28034, Madrid, Spain
| |
Collapse
|
4
|
Abstract
The ideal operative solution to giant paraesophageal hernias involves a complex evaluation of the functional anatomy and the intraoperative assessment of both esophageal length and crural closure tension. The addition of surgical adjuncts such as extended transmediastinal dissection, Collis gastroplasty, and mesh reinforcement are all necessary, on an individualized basis, to address these 2 primary causes of hernia recurrence. We discuss the options available.
Collapse
Affiliation(s)
- Matthew Rochefort
- Division of Thoracic Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Jon O Wee
- Esophageal Surgery, Division of Thoracic Surgery, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| |
Collapse
|
5
|
Autologous Dermis Graft Implantation: A Novel Approach to Reinforcement in Giant Hiatal Hernias. Case Rep Surg 2018; 2018:9069430. [PMID: 29854546 PMCID: PMC5964430 DOI: 10.1155/2018/9069430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives Nonreinforced tensile repair of giant hiatal hernias is susceptible to recurrence, and the role of mesh graft implantation remains controversial. Creating a new and viable choice without the use of high-cost biological allografts is desirable. This study presents the application of dermis graft reinforcement, a cost-efficient, easily adaptable alternative, in graft reinforcement of giant hiatal hernia repairs. Methods A 62-year-old female patient with recurrent giant hiatal hernia (9 × 11 cm) and upside down stomach, immediately following the Belsey repair done in another department, was selected for the pilot procedure. The standard three-stitch nonabsorbable reconstruction of diaphragmatic crura was undertaken via laparoscopic approach. A 12 × 6 cm dermis autograft was harvested from the loose abdominal skin. “U” figure onlay reinforcement of diaphragm closure was secured with titanium staples. The procedure was completed with a standard Dor fundoplication. One- and seven-month follow-ups were conducted. Results No short-term postoperative complications were observed. One-month follow-up showed normal anatomical location of abdominal viscera on computed tomography imaging. High-resolution manometry showed normal lower esophageal sphincter pressure. Preoperative abdominal complaints were resolved. Procedural costs were lower than the average cost following mesh graft reinforcement. Conclusion Dermis graft reinforcement is a cheap, easily adaptable procedure in the repair of giant hiatal hernias, even in the setting of laparoscopic reoperative procedure.
Collapse
|
6
|
Hiatal hernia and gastroesophageal reflux: Study of collagen in the phrenoesophageal ligament. Surg Endosc 2016; 30:5091-5098. [DOI: 10.1007/s00464-016-4858-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/03/2016] [Indexed: 01/11/2023]
|
7
|
Bjelovic M, Babic T, Spica B, Gunjic D, Veselinovic M, Bascarevic V. The use of autologous fascia lata graft in the laparoscopic reinforcement of large hiatal defect: initial observations of the surgical technique. BMC Surg 2015; 15:22. [PMID: 25849293 PMCID: PMC4359456 DOI: 10.1186/s12893-015-0008-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/10/2015] [Indexed: 12/15/2022] Open
Abstract
Background Even though there is no consensus, many authors believe that in the cases of large hiatal defects, structurally altered crura and/or absence of peritoneal lining, a crural reinforcement should be performed. Reinforcement could be performed with different techniques and different type of mesh, either synthetic or biologic. The disadvantages of mesh repair include the possibility of serious complications and increased costs especially in the usage of composite or biologic mesh. Methods The study includes 10 cases of reinforced primary suture line of the pillars with autologous fascia lata, in elective laparoscopic repair of the giant PEH with a large hiatal defect and friable crura. After intraopreative confirmation of the large hiatal defect (hiatal surface area of more than 8 cm2) and friable crura, an autologous fascia lata graft was harvested in the usual manner and placed in on-lay fashion to reinforce the pillar suture line. We analyzed surgical technique, complications, and initial follow-up of the patients. Results Average hiatal surface area (HSA) in our series was 10.6 cm2 (range 8.1 to 14.4 cm2). The average duration of operation was 203.9 min/3.4 hours (range 160–250 min). Except for a mild hematoma in the harvesting region that resolved spontaneously, there were no procedure related complications and 30 days mortality rate was zero. The average postoperative length of stay was 6.5 days (5–8 days). Out of 10 patients, 5 completed the annual follow-up visit, while 8 completed a 6- month follow-up visit. So far there is no hernia recurrence and/or problems with swallowing function. However, one patient has felt a mild discomfort in the harvested region that does not influence normal daily activities. Conclusions Autologous fascia lata graft hiatal reinforcement represents a technically feasible, easy, and available option for the on-lay reinforcement of large hiatal defects with friable crura in the laparoscopic repair of giant PEHs.
Collapse
Affiliation(s)
- Milos Bjelovic
- University of Belgrade, School of Medicine, Belgrade, Serbia. .,Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Tamara Babic
- Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Bratislav Spica
- Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dragan Gunjic
- Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Veselinovic
- Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Violeta Bascarevic
- Department of Plastic Surgery, Special Hospital Banjica, Belgrade, Serbia
| |
Collapse
|
8
|
Bell RCW, Kurian AA, Freeman KD. Laparoscopic anti-reflux revision surgery after transoral incisionless fundoplication is safe and effective. Surg Endosc 2014; 29:1746-52. [PMID: 25380707 DOI: 10.1007/s00464-014-3897-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 09/11/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Transoral incisionless fundoplication (TIF) treats gastroesophageal reflux disease (GERD) by creating a full-thickness esophagogastric plication using transmural fasteners. If unsuccessful, revision laparoscopic anti-reflux surgery (rLARS) may be performed. This study evaluated operative findings and clinical outcomes of rLARS in 28 patients with prior primary TIF. METHODS Intraoperative findings, complications, and symptomatic outcomes with GERD health-related quality of life (GERD-HRQL) were evaluated prospectively in patients having rLARS after TIF. Results are median with interquartile range (IQR). RESULTS Between 03/2009 and 08/2013, 28 patients underwent rLARS at 14 (13-50) months post-TIF for recurrent symptoms after initial improvement. Pre-rLARS endoscopies found hiatal hernia (9) and wrap disruption (12). All revisions were completed laparoscopically in 88 (70-90) min. Eight patients underwent partial fundoplication, the rest Nissen. No intraoperative or postoperative complications occurred. Operative findings included: No axial hernia in 65%; Dense adhesions in 14%; Fasteners incorporating the lateral crus in 95%; Traction diverticuli from esophagus to crura in 21%. Residual plication was noted anteriorly in 75%, posteriorly in 0%. Operative approaches: (1) Areas where the TIF fundoplication remained were left intact. This necessitated rolling the fundoplication over the fused area to prevent an endoscopic appearance of 'fold'. (2) Fasteners were cut and left to migrate into the lumen, rather than being pulled out. (3) In 8 patients with fusion of the lateral crus to TIF fundoplication and no axial hernia, revision fundoplication was performed without mediastinal mobilization but with posterior hernia repair. One patient required subsequent surgery for small paraesophageal hernia, one for refractory gas-bloat after rLARS. Dysphagia in 2 patients resolved with dilation. GERD-HRQL improved from a median of 20 (8-27) pre-TIF and 10 (1-20) pre-rLARS to 3 (0-4) at 28 months (12-40) post-rLARS (p = 0.020 for pre-rLARS to post-rLARS). CONCLUSION rLARS after TIF can be performed safely with excellent clinical outcomes.
Collapse
|
9
|
Priego Jiménez P, Salvador Sanchís JL, Angel V, Escrig-Sos J. Short-term results for laparoscopic repair of large paraesophageal hiatal hernias with Gore Bio A® mesh. Int J Surg 2014; 12:794-7. [PMID: 24947948 DOI: 10.1016/j.ijsu.2014.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/24/2014] [Accepted: 06/02/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates in comparison with primary suture repair. One of the most debated issues is the risk of complications related to the use of the prosthesis, such as esophageal erosion and postoperative dysphagia. The aim of this study is to present our short-terms results in the treatment of laparoscopic paraesophageal hiatal hernia (LPHH) with a synthetic polyglycolic acid:trimethylene carbonate mesh (Gore Bio A(®)). METHODS From January 2011 to December 2012, 10 patients with large paraesophageal hiatal hernias and hiatal defect over 5 cm were included. Primary simple suture of the crura and additional reinforcement with a Gore Bio A(®) mesh was performed. Hiatal hernia or gastroesophageal reflux disease (GERD) symptoms recurrence, dysphagia and mesh-related complications were investigated. RESULTS Of the 10 patients undergoing mesh repair, there were 7 women and 3 men with a mean age of 65.5 years. All operations were completed laparoscopically. Median postoperative stay was 3 days. After a median follow-up of 20.3 months, one patient developed a recurrent hiatal hernia (10%). There were no mesh-related complications. CONCLUSIONS The use of Gore Bio A(®) mesh for the laparoscopic repair of large paraesophageal hiatal hernias is safe and with a reasonably low recurrence rate in this short-term study. Additional long-term studies with ample numbers carried out for years will be necessary to see if this synthetic mesh is not only safe but also successful in the prevention of recurrences.
Collapse
Affiliation(s)
- Pablo Priego Jiménez
- Department of General Surgery, Upper Gastrointestinal Unit, Hospital General Castellón, Avda. Benicassim s/n, 12004 Castellón, Spain.
| | - José Luis Salvador Sanchís
- Department of General Surgery, Upper Gastrointestinal Unit, Hospital General Castellón, Avda. Benicassim s/n, 12004 Castellón, Spain
| | - Vicente Angel
- Department of General Surgery, Upper Gastrointestinal Unit, Hospital General Castellón, Avda. Benicassim s/n, 12004 Castellón, Spain
| | - Javier Escrig-Sos
- Department of General Surgery, Upper Gastrointestinal Unit, Hospital General Castellón, Avda. Benicassim s/n, 12004 Castellón, Spain
| |
Collapse
|
10
|
Silecchia G, Iossa A, Cavallaro G, Rizzello M, Longo F. Reinforcement of hiatal defect repair with absorbable mesh fixed with non-permanent devices. MINIM INVASIV THER 2014; 23:302-8. [PMID: 24773371 DOI: 10.3109/13645706.2014.909853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
AIM 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.
Collapse
Affiliation(s)
- Gianfranco Silecchia
- Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery & Bariatric Center of Excellence, University of Rome , Latina , Italy
| | | | | | | | | |
Collapse
|
11
|
Fuchs J, Schafbuch L, Ebinger M, Schäfer JF, Seitz G, Warmann SW. Minimally invasive surgery for pediatric tumors - current state of the art. Front Pediatr 2014; 2:48. [PMID: 24918096 PMCID: PMC4042474 DOI: 10.3389/fped.2014.00048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 05/14/2014] [Indexed: 12/29/2022] Open
Abstract
During recent years, minimally invasive surgery (MIS) has become the standard approach for various operations in infants and children. This also holds true for surgery in children with solid tumors. Meanwhile, more and more oncological biopsies and resections are being performed laparoscopically or thoracoscopically. Despite its increasing role in pediatric tumor surgery, the different national and international multicenter trial groups have not yet implemented MIS within guidelines and recommendations in most of the current treatment protocols. An increasing number of reports describe a potential role of MIS in the different entities of pediatric surgical oncology. Over the time, there has been a diverse development of this approach with regard to the different neoplasms. The aim of this article is to give an overview and to describe the current state of the art of MIS in pediatric solid tumors.
Collapse
Affiliation(s)
- Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Luana Schafbuch
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Martin Ebinger
- Department of Pediatric Oncology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Jürgen F Schäfer
- Department of Clinical and Interventional Radiology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Guido Seitz
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen , Tübingen , Germany
| | - Steven W Warmann
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital Tübingen , Tübingen , Germany
| |
Collapse
|