RESUMEN
INTRODUCTION: We report the results of a multicenter trial evaluating a unique, biological mesh (MIROMESH) derived from decellularized porcine liver for hiatal cruralplasty during laparoscopic PEHR. METHODS: 41 subjects underwent a laparoscopic PEHR which included primary crural closure, and MIROMESH onlay. Subjects were assessed at 2-weeks and 6, 12, 18 and 24 months using the SF-36, GERD-HRQL questionnaire, and VAS GERD related symptoms, and UGI. RESULTS: Mean procedure time was 143.0 (±45.2) minutes, 93% had a Type III hiatal hernia and median LOS was 3 days. Of 27 patients available for 2 years follow up, no patients required surgical reintervention for symptomatic hernia recurrence or adverse events. Radiographic follow up revealed a 10% hiatal hernia recurrence rate. GERD HRQL scores were significantly improved from baseline to two years follow up. All the GERD symptoms measured showed significant and sustained improvement at all post-operative time periods. CONCLUSION: The utilization of MIROMESH for crural reinforcement during laparoscopic PEHR resulted in excellent symptomatic improvement in our multicenter trial with a 10% 2 year radiographic recurrence rate.
Asunto(s)
Bioprótesis , Hernia Hiatal/cirugía , Herniorrafia/métodos , Laparoscopía , Mallas Quirúrgicas , Adulto , Anciano , Animales , Femenino , Humanos , Hígado , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Diseño de Prótesis , PorcinosRESUMEN
BACKGROUND AND OBJECTIVES: The contemporary results of open incisional and ventral hernia repair are unsatisfactory because of high recurrence rates and morbidity levels. Laparoscopic repair of ventral and incisional hernias (LIVH) can be accomplished in a simple, reproducible manner while dramatically lowering recurrence rates and morbidity. METHODS: One hundred consecutive patents underwent laparoscopic repair of their ventral and incisional hernias over a 27-month period. Composix mesh and Composix E/X mesh (Davol Inc., Cranston, RI) were utilized for the repairs. Transfixion sutures were not used. RESULTS: All repairs were completed laparoscopically. No conversions to open techniques were necessary. No postoperative infections have been observed. One recurrent hernia was identified and subsequently repaired with the same technique. CONCLUSIONS: LIVH can be accomplished with a dramatic reduction in recurrence rates and morbidity. The technique for this repair is still in a state of evolution. The construction and handling characteristics of this particular type of mesh have allowed us to eliminate transfixion sutures and to simplify the repair technique while maintaining a very low recurrence rate.