Laparoscopic Repair of Giant Hiatal Hernias with New Mesh Graft: Long-Term Results
Background. The recurrence rate after alloplasty of giant (with a surface area of esophageal hiatus more than 20 cm2) hiatal hernia is 40 %. Objective: to study long-term outcomes of giant hernias repair using fundamentally new transplant, based on the principle repair using frame frame without any fixation.
Material and Methods. From November 2010 to February 2013 using the new method we operated 44 patients with giant hiatal hernia of II, III and IV types. The average surface area of esophageal hiatus was 37.5 ± 15.6 (21.7–75.4) cm2. Rebound HRD-Hiatus hernia graft is a lightweight polytetrafluoroethylene triangular mesh with notch for the esophagus (heart-shaped) with a size 5.5 × 6.0 of 4.5 × 5.5 cm, stretched over Nitinol frame shape memory. It was fixed to the edges of esophageal hiatus behind esophagus with 3–5 interrupted sutures, thus providing repair with frame without any fixation. All patients underwent Nissen fundoplication with fixing cuff to the diaphragm so as to avoid direct contact of transplant with the esophagus.
Results. The average time of transplant setting was 24.8 ± 5.6 minutes (15–35). Intraoperative complications related to repair, were not detected. The average postoperative hospital stay was 5.0 ±
± 1.5 days (1–8). Long-term results were studied in 27 patients in a mean of 20.8 ± 4.4 (14–28) months. Analysis of symptoms on a visual analogue scale before and after the operation showed a significant reduction in the intensity of heartburn, pains, dysphagia, and extraesophageal symptoms. The quality of life on a scale of GERD-HRQL was significantly improved. Reflux esophagitis stage A after surgery was only in 1 patient, while it was absent before operation only in 9 % of patients. DeMeester index and time of passage of barium through the esophagus were significantly reduced. In X-ray examination, true anatomic recurrence was not detected. Two false anatomical relapses and 2 symptomatic functional relapses were found. Long-term functional dysphagia and esophageal strictures were not detected.
Conclusions. In assessing the long-term results, a new method is characterized by the absence of true anatomic recurrence and esophageal complications and can be compared to standard techniques.
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