Mesh reinforcement of hiatoplasty for large hiatal hernias
EAES Academy. Bintintan V. 07/05/22; 363176; P221
Dr. Vasile Bintintan
Contributions
Contributions
Abstract
Introduction:
Simple closure of the hernia defect in large hiatal hernias is associated with high risk of recurrence and the prospect of a second operation. Reinforcement of the hiatoplasty with a mesh reduces these risks but is associated with other inconveniences.
Material and method:
We routinely reinforce the hiatoplasty with a U shaped dual mesh prosthesis placed around the esophagus and fixed centrally to the diaphragmatic pillars and in the periphery to the diaphragm if the diameter of the hernia exceedes 5 cm or if the hiatoplasty is under tension. A Nissen or Toupet fundoplication is used according to the anatomical and functional status of the esophgus and gastric fundus. The technique is discussed in a presentation video.
Results:
The first 25 patients operated with this technique were included in a prospective study. The mesh was anchored in all cases either using a combination of EndoHernia 120 clips and sutures or sutures alone. In one early case, postoperative cardiac tamponade occured 24h after surgery due to injury from an incompletly closed clip. No other intraoperative or early postoperative incidens were encontered. There were no complications related to mesh migration. There was no recurrence of the hernia, no disphagia beyond 6 months postoperatively and the reflux score improved significantly in all patients.
Conclusions. With meticulous technique, mesh reinforcement of the hiatoplasty is a safe procedure in experienced hands and reduces the the long-term risk of recurrence.
Simple closure of the hernia defect in large hiatal hernias is associated with high risk of recurrence and the prospect of a second operation. Reinforcement of the hiatoplasty with a mesh reduces these risks but is associated with other inconveniences.
Material and method:
We routinely reinforce the hiatoplasty with a U shaped dual mesh prosthesis placed around the esophagus and fixed centrally to the diaphragmatic pillars and in the periphery to the diaphragm if the diameter of the hernia exceedes 5 cm or if the hiatoplasty is under tension. A Nissen or Toupet fundoplication is used according to the anatomical and functional status of the esophgus and gastric fundus. The technique is discussed in a presentation video.
Results:
The first 25 patients operated with this technique were included in a prospective study. The mesh was anchored in all cases either using a combination of EndoHernia 120 clips and sutures or sutures alone. In one early case, postoperative cardiac tamponade occured 24h after surgery due to injury from an incompletly closed clip. No other intraoperative or early postoperative incidens were encontered. There were no complications related to mesh migration. There was no recurrence of the hernia, no disphagia beyond 6 months postoperatively and the reflux score improved significantly in all patients.
Conclusions. With meticulous technique, mesh reinforcement of the hiatoplasty is a safe procedure in experienced hands and reduces the the long-term risk of recurrence.
Introduction:
Simple closure of the hernia defect in large hiatal hernias is associated with high risk of recurrence and the prospect of a second operation. Reinforcement of the hiatoplasty with a mesh reduces these risks but is associated with other inconveniences.
Material and method:
We routinely reinforce the hiatoplasty with a U shaped dual mesh prosthesis placed around the esophagus and fixed centrally to the diaphragmatic pillars and in the periphery to the diaphragm if the diameter of the hernia exceedes 5 cm or if the hiatoplasty is under tension. A Nissen or Toupet fundoplication is used according to the anatomical and functional status of the esophgus and gastric fundus. The technique is discussed in a presentation video.
Results:
The first 25 patients operated with this technique were included in a prospective study. The mesh was anchored in all cases either using a combination of EndoHernia 120 clips and sutures or sutures alone. In one early case, postoperative cardiac tamponade occured 24h after surgery due to injury from an incompletly closed clip. No other intraoperative or early postoperative incidens were encontered. There were no complications related to mesh migration. There was no recurrence of the hernia, no disphagia beyond 6 months postoperatively and the reflux score improved significantly in all patients.
Conclusions. With meticulous technique, mesh reinforcement of the hiatoplasty is a safe procedure in experienced hands and reduces the the long-term risk of recurrence.
Simple closure of the hernia defect in large hiatal hernias is associated with high risk of recurrence and the prospect of a second operation. Reinforcement of the hiatoplasty with a mesh reduces these risks but is associated with other inconveniences.
Material and method:
We routinely reinforce the hiatoplasty with a U shaped dual mesh prosthesis placed around the esophagus and fixed centrally to the diaphragmatic pillars and in the periphery to the diaphragm if the diameter of the hernia exceedes 5 cm or if the hiatoplasty is under tension. A Nissen or Toupet fundoplication is used according to the anatomical and functional status of the esophgus and gastric fundus. The technique is discussed in a presentation video.
Results:
The first 25 patients operated with this technique were included in a prospective study. The mesh was anchored in all cases either using a combination of EndoHernia 120 clips and sutures or sutures alone. In one early case, postoperative cardiac tamponade occured 24h after surgery due to injury from an incompletly closed clip. No other intraoperative or early postoperative incidens were encontered. There were no complications related to mesh migration. There was no recurrence of the hernia, no disphagia beyond 6 months postoperatively and the reflux score improved significantly in all patients.
Conclusions. With meticulous technique, mesh reinforcement of the hiatoplasty is a safe procedure in experienced hands and reduces the the long-term risk of recurrence.
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