Soto GM

Language: Spanish
References: 8
Page: 260-264
PDF size: 107.31 Kb.

ABSTRACT

Objective: To report the experience obtained in open plasties of the esophageal hiatus in selected patients, using composite mesh (polyprolene and polytetrafluoroethylene, PTFE).
Setting: Regional Military Hospital of Acapulco, Gro. (Second level health care hospital).
Design: Prospective, descriptive, longituinal study.
Patients and methods: Patients with a high risk of developing hiatal hernia recurrence were included in the study: these patients were subjected to an open Nissen fundoplication and esophageal hiatus plasty with a composite mesh. We recorded age, gender, concomitant diseases, previous antireflux surgery, approximate estimation of the hiatus’ diameter, firmness of the pillars, and degree of tension when approaching them, trans and post-operative complications, as well as recurrence of the hiatal hernia confirmed through radiology. Follow-up until this date has been of 3 years.
Results: Eight patients were subjected to this surgery; their average age was of 63 years. Five patients were women and the other three were men. Two had diabetes mellitus and two coursed with morbid obesity. Previous antireflux surgery had been performed in three patients, demonstrating radiologically migration of the fundoplication to the thorax. The estimated diameter of the hiatus was in average of 7 cm. Pillars were found weakened in all patients and with moderate to strong tension when trying to approach them. Neither trans- nor post-operative complications were encountered. Radiological control on the third year after surgery revealed no recurrences of the hernia.
Conclusion: The series described herein is small and the follow-up time is short; however, the obtained results are encouraging in terms that the use of the composite mesh in the open plasty of the esophageal hiatus, in selected patients with high probability of recurrence, is a technically simple procedure, apparently efficacious in preventing hiatal hernia recurrence at the short and mid-term, without complications due to the mesh.

REFERENCES

1. Targarona EM, Balagué C, Garriga J, Trías M. Mallas en el hiato: Una controversia no solucionada. Rev Mex Cir End 2004; 5: 44-57.

2. Castillo GA. Enfermedad por reflujo gastroesofágico. En: Aguirre RR, de la Garza BL Editores. Tratado de Cirugía General. México D.F. El Manual Moderno 2003: 599-615.

3. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, et al. Laparoscopic repair of large type III hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg 2000; 190: 553-561.

4. Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP. A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 2002; 137: 649-652.

5. Khaitan L, Houston H, Holzman M, Richards W. Laparoscopic paraesophageal hernia repair has an acceptable recurrence rate. Am Surg 2002; 68: 546-552.

6. Casaccia M, Torelli P, Panaro F, Cavaliere D, Ventura A, Valente U. Laparoscopic physiological hiatoplasty for hiatal hernia: new composite “A”-shaped mesh. Physical and geometrical analysis and preliminary clinical results. Surg Endosc 2002; 16: 1441-1445.

7. Targarona EM, Novell J, Vela S, Cerdán G, Bendahan G, Torrubia S, et al. Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia. Surg Endosc 2004; 18: 1045-50.

8. Johnson JM, Carmody BJ, Jamal MK, DeMaría EJ. Onlay hiatal reinforcement utilizing human acellular dermal matrix: three case series. Surg Innov 2005; 12: 239-241.