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Sillcox R, Jackson HT. Mesh Versus No Mesh for Cruroplasty. J Laparoendosc Adv Surg Tech A 2022; 32:1144-1147. [PMID: 35980377 DOI: 10.1089/lap.2022.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This review describes the evolution of hiatal hernia repair for the past several decades: From the use of a primary tissue repair only, the subsequent inclusion of synthetic mesh and its complications, to current day indications for mesh use. We will highlight the recent research in biologic and composite meshes as well as the ongoing limitations in studying their efficacy. Finally, we will describe our institutional indications and surgical technique practices in the utilization of biologic mesh.
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Affiliation(s)
- Rachel Sillcox
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Hope T Jackson
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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2
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Hany M, Ibrahim M, Zidan A, Torensma B. Acute Parahiatal Hernia After Sleeve Gastrectomy: a Case Report. Obes Surg 2022; 32:3210-3212. [PMID: 35799028 DOI: 10.1007/s11695-022-06200-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt. .,Madina Women's Hospital, IFSO Centre of Excellence, Alexandria, Egypt.
| | - Mohamed Ibrahim
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Ahmed Zidan
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Bart Torensma
- Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Boru CE, Manolescu N, Ulmeanu DI, Copca N, Constantinica V, Copaescu C, Silecchia G. Platelet-rich plasma PRP vs. absorbable mesh as cruroplasty reinforcement: a study on an animal model. MINIM INVASIV THER 2020; 31:252-261. [PMID: 32700986 DOI: 10.1080/13645706.2020.1795686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Reinforcement of posterior cruroplasty has been proposed to minimize the failure of hiatal hernia repair (HHR). The applications of autologous platelet-rich plasma (PRP) and absorbable mesh are barely reported in this area. AIMS To analyze local macroscopic and microscopic changes induced by mesh vs. PRP as reinforcement of HHR, using a reliable laparoscopic experimental porcine model. MATERIAL AND METHODS This prospective, comparative pilot study was conducted on 14 female pigs, aged four to six months. An iatrogenic hiatal defect was laparoscopically simulated and repaired, reinforced with Bio-A® mesh (group A) or PRP (group B). Specimen retrieval was performed after seven months for histopathological (HP) examination. RESULTS No local or general complications were registered, with complete resorption of reinforcements, that determined inflammatory infiltrates with local collagen production and tissue neo-vascularization. Group A had an increased mean chronic inflammation score (p = .3061), showing significant sclerotic collagenizing process. PRP enhanced angiogenesis, collagenizing, myofibroblast recruitment and tissue ingrowth. CONCLUSIONS No residual materials or evidence of anatomical distortion were found. Animal model was safe and reliable. This is the first report of complete absorption of Bio-A® positioned on crural area. HP results suggest the clinical application of PRP in HHR as a promising co-adjuvant to local remodeling and healing.Abbreviations: ASA: American Society of Anesthesiologists; AB: Alcian Blue; PAS: Periodic Acid-Schiff; CP: platelet concentrate; fPC: filtered plasma concentrate; GERD: gastro-esophageal reflux disease; HSA: hiatal surface area; HHR: hiatal hernia repair; HP: histopathological; HH: hiatal hernia; HE: hematoxylin and eosin; HR: hiatus repair alone; HRM: hiatus repair and acellular dermal matrix; NM: Nicolae Manolesccu; LNF: laparoscopic Nissen fundoplication; PC: posterior cruroplasty; PPP: platelet-poor plasma; RP: platelet-rich plasma.
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Affiliation(s)
- Cristian E Boru
- General Surgery and Bariatric Centre of Excellence IFSO-EC, AUSL LT-ICOT, Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Latina, Italy.,General Surgery and Transplantation Department, 'Sf. Maria' Clinical Hospital, Bucharest, Romania
| | - Nicolae Manolescu
- Department of Clinical Anatomic Pathology, Faculty of Veterinary Medicine, 'Spiru Haret' University, Bucharest, Romania
| | - Dan I Ulmeanu
- General and Thoracic Surgery Department, 'Regina Maria Baneasa' Hospital, Bucharest, Romania
| | - Narcis Copca
- General Surgery and Transplantation Department, 'Sf. Maria' Clinical Hospital, Bucharest, Romania
| | - Victor Constantinica
- General Surgery and Transplantation Department, 'Sf. Maria' Clinical Hospital, Bucharest, Romania
| | - Catalin Copaescu
- General Surgery and Bariatric Centre of Excellence IFSO EAC-EC, Ponderas Academic Hospital, Bucharest, Romania
| | - Gianfranco Silecchia
- General Surgery and Bariatric Centre of Excellence IFSO-EC, AUSL LT-ICOT, Department of Medico-Surgical Sciences and Biotechnologies, University La Sapienza of Rome, Latina, Italy
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Ilyashenko VV, Grubnyk VV, Grubnik VV. Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair. Surg Endosc 2018; 32:3592-3598. [DOI: 10.1007/s00464-018-6087-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 02/01/2018] [Indexed: 12/23/2022]
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Prusa AM, Kristo I, Rieder E, Ringhofer C, Asari R, Miholic J, Schoppmann SF. Tension-Free Inlay Repair of Large Hiatal Hernias Using Dual-Sided Composite PTFE/ePTFE Meshes in Laparoscopic Surgery for Gastroesophageal Reflux Disease. J Laparoendosc Adv Surg Tech A 2017; 27:710-714. [PMID: 28445106 DOI: 10.1089/lap.2016.0371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with gastroesophageal reflux disease (GERD) also frequently suffer from concomitant hiatal hernia. It has been described that a preoperative hiatal hernia of ≥3 cm is associated with a more than threefold relative risk for reflux symptom recurrence after fundoplication without mesh reinforcement. In this report, we describe our experience with the implantation of dual-sided composite PTFE/ePTFE meshes in a tension-free fashion during laparoscopic antireflux surgery (LARS). METHODS A prospective database containing data of all patients undergoing LARS and hiatal hernia repair with mesh implantation from January 2009 until December 2014 was interrogated. Ten patients with preoperative esophageal high resolution manometry and 24-hour pH impedance monitoring because of symptoms suggestive of GERD who received hiatal repair using dual-sided meshes in inlay technique were identified and included in this analysis. RESULTS There were no conversions to open surgery in the study group. Median operative time was 138 minutes (interquartile range Q1-Q3: 119-151 minutes) and average length of postoperative stay was 3.5 days (interquartile range Q1-Q3: 2.3-4.0 days). During a median follow-up period of 43.3 months (interquartile range Q1-Q3: 18.9-47.1 months), no redo operations had to be performed. Noteworthy, 2 patients complained about dysphagia (20%) during follow-up, but symptoms resolved after endoscopic interventions. CONCLUSIONS Tension-free inlay repair of large hiatal hernias using dual-sided composite PTFE/ePTFE meshes during LARS provides promising results. It provides satisfactory symptom relief and prolonged control of GERD. Further studies to validate its efficiency in a larger collective are needed.
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Affiliation(s)
- Alexander M Prusa
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria
| | - Ivan Kristo
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria .,2 Manometry Laboratory, Department of Surgery, Medical University of Vienna , Vienna, Austria
| | - Erwin Rieder
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria
| | - Claudia Ringhofer
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria .,2 Manometry Laboratory, Department of Surgery, Medical University of Vienna , Vienna, Austria
| | - Reza Asari
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria
| | - Johannes Miholic
- 3 Department of Surgery, Medical University of Vienna , Vienna, Austria
| | - Sebastian F Schoppmann
- 1 Department of Surgery, Upper GI Service and Research, Medical University of Vienna , Vienna, Austria .,2 Manometry Laboratory, Department of Surgery, Medical University of Vienna , Vienna, Austria
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Ercan M, Aziret M, Karaman K, Bostancı B, Akoğlu M. Dual mesh repair for a large diaphragmatic hernia defect: An unusual case report. Int J Surg Case Rep 2016; 28:266-269. [PMID: 27756029 PMCID: PMC5067298 DOI: 10.1016/j.ijscr.2016.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/03/2016] [Accepted: 10/05/2016] [Indexed: 02/07/2023] Open
Abstract
Delayed right sided of diaphragm rupture or hernia is a rare. Most of the diaphragmatic hernia patients are asymptomatic. The main treatment approach is repair of the diaphragmatic hernia defect after reduction of the organs and tissues into the abdominal cavity. A dual mesh repair can be used for a large diaphragm hernia.
Introduction Diaphragmatic hernia secondary to traumatic rupture is a rare entity which can occur after stab wound injuries or blunt abdominal traumas. We aimed to report successfully management of dual mesh repair for a large diaphragmatic defect. Case report A 66-year-old male was admitted with a right sided diaphragmatic hernia which occurred ten years ago due to a traffic accident. He had abdominal pain with worsened breath. Chest X-ray showed an elevated right diaphragm. Further, thoraco-abdominal computerized tomography detected herniation a part of the liver, gallbladder, stomach, and omentum to the right hemi-thorax. It was decided to diaphragmatic hernia repair. After an extended right subcostal laparotomy, a giant right sided diaphragmatic defect measuring 25 × 15 cm was found in which the liver, gallbladder, stomach and omentum were herniated. The abdominal organs were reducted to their normal anatomic position and a dual mesh graft was laid to close the diaphragmatic defect. Patients’ postoperative course was uneventful. Discussion Diaphragmatic hernia secondary to trauma is more common on the left side of the diaphragm (left/right = 3/1). A right sided diaphragmatic hernia including liver, stomach, gallbladder and omentum is extremely rare. The main treatment of diaphragmatic hernias is primary repair after reduction of the herniated organs to their anatomical position. However, in the existence of a large hernia defect where primary repair is not possible, a dual mesh should be considered. Conclusion A dual mesh repair can be used successfully in extensive large diaphragmatic hernia defects when primary closure could not be achieved.
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Affiliation(s)
- Metin Ercan
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Mehmet Aziret
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey.
| | - Kerem Karaman
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Birol Bostancı
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
| | - Musa Akoğlu
- Sakarya University of Faculty of Medicine, Department of General Surgery, Sakarya, Turkey
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Long-term outcomes of cruroplasty reinforcement with composite versus biologic mesh for gastroesophageal reflux disease. Surg Endosc 2015; 30:2865-72. [DOI: 10.1007/s00464-015-4570-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/15/2015] [Indexed: 12/13/2022]
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Tanrikulu Y, Kar F, Yalcin B, Yilmaz G, Temi V, Cagsar M. The importance of the mesh shape in preventing recurrence after Nissen fundoplication. Int J Clin Exp Med 2015; 8:9684-9691. [PMID: 26309643 PMCID: PMC4537959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/03/2015] [Indexed: 06/04/2023]
Abstract
Gastro esophageal reflux disease (GERD) is the most common gastrointestinal disorder and often is associated with hiatal hernia (HH). Nissen fundoplication is the most common surgical treatment method. Despite surgical treatment, recurrence rate is still high. In this study, we aimed to identify the importance of the mesh shape in preventing recurrence after Nissen fundoplication. A hundred twenty two patients who operated Nissen fundoplication owing to GERD and/or HH were evaluated. Nissen fundoplication was made all patients. Patients were divided into three groups according to hiatoplasty procedure; group 1 (V-shaped mesh), group 2 (V-shaped mesh + Fibrin glue), and group 3 (special designed mesh, Kar's mesh). Groups were compared regarding intraoperative, postoperative early- and long-term complications. Mean age was 42.75 years, and male to female ratio was 1:2.98. The mean follow-up period was 27 mounts. There was no mortality during follow-up. The most common presenting symptom was heartburn (93.4%). There wasn't difference between groups in terms of the intraoperative complications and postoperative early-term complications. The overall recurrences rate was 4.9% and dysphagia > 3 months rate was 1.6%. No recurrence was not observed in group 3, while recurrence was observed in 4 patients in group 1 (P = 0.030). Patients should be carefully selected for surgery because complication rate is high despite successful anti-reflux surgical treatment. In this study, we have used a special designed mesh. We believe that this special designed mesh can be used safely and effectively in anti-reflux surgery because recurrence and complications were not observed.
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Affiliation(s)
- Yusuf Tanrikulu
- Department of General Surgery, Zonguldak Ataturk State Hospital Zonguldak 67100, Turkey
| | - Fatih Kar
- Department of General Surgery, Zonguldak Ataturk State Hospital Zonguldak 67100, Turkey
| | - Boran Yalcin
- Department of General Surgery, Zonguldak Ataturk State Hospital Zonguldak 67100, Turkey
| | - Gokhan Yilmaz
- Department of General Surgery, Zonguldak Ataturk State Hospital Zonguldak 67100, Turkey
| | - Volkan Temi
- Department of General Surgery, Zonguldak Ataturk State Hospital Zonguldak 67100, Turkey
| | - Mithat Cagsar
- Department of General Surgery, Zonguldak Ataturk State Hospital Zonguldak 67100, Turkey
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