2005 SAGES Abstracts

ABSTRACTS
Friday, April 15, 2005
Conclusion: LNF provides an efficient treatment of GERD up to
5 years, but can also be an effective treatment of associated GI
symptoms. However, new bowel symptoms can develop after
LNF and patients should be aware of that risk.
S125
MESH HIATOPLASTY FOR PARAESOPHAGEAL HERNIAS AND
FUNDOPLICATIONS, Jason M Johnson DO, Alfredo M
Carbonell DO,Brennan J Carmody MD,Mohammad K Jamal
MD,Eric J DeMaria MD, Virginia Commonwealth University,
Richmond, Virginia
Little Grade A medical evidence exists to guide the foregut
surgeon in the decision to use prosthetic material for hiatal
closure in anti-reflux surgery. Therefore, we compiled and analyzed
all available literature to determine if the use of prosthetic
mesh for hiatoplasty in routine laparoscopic fundoplications
(LF) or in the repair of large (> 5 cm) paraesophageal hernias
(PEH) would decrease recurrence.
A literature search was performed using an inclusive list of relevant
search terms via Medline/PubMed to identify
papers(n=19) in which prosthetic material was used in the
repair of the crura for patients undergoing laparoscopic PEH
reduction and/or LF. Case series(n=5), retrospective
reviews(n=7), and prospective randomized(n=3) and non-randomized(n=4)
trials were identified. Laparoscopic
procedures(n=1312) were performed for either PEH, GERD,
hiatal hernia or a combination of the three. Group A (n=679)
were patients who had primary suture repair of the crura, and
Group B (n=633) had repair with either interposition of mesh
to close the hiatus or onlay of prosthetic material after closure.
The use of mesh was associated with a decrease in recurrence
when compared with primary suture repair in both the LF and
PEH groups. Mean follow-up did not differ between groups
(21.1 vs. 22.1 months). None of the papers cited any instance
of prosthetic erosion into the gastrointestinal tract.The data
support the use of prosthetic materials for hiatal repair for
both routine LF and in the repair of large PEHs. Future randomized
trials are needed to confirm that mesh repair is superior
to simple crural closure, but the current study supports
use of prosthetic material to improve outcomes in LF and PEH
repair. Persistent concerns about prosthetic erosion, unconfirmed
in this comprehensive review, suggest that biomaterials
should be further evaluated to determine if they offer the benefits
of improved hiatoplasty outcomes while avoiding the
small risk of erosion.
SAGES 2005
http://www.sages.org/
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