421 USE OF BIOABSORBABLE MESH TO REINFORCE HIATAL CLOSURE—EARLY RESULTS

Abstract

Abstract The hiatoplasty is one of the keypoints of hiatal hernia surgery. Reherniation is known to be a frequent reason for recurrence and reoperation. Biodegradable materials for reinforcement have been. shown in some series to reduce these outcomes with very low risks of mesh-related complications. Long term reports, however, have shown conflicting results. This may be because meshes have been used in complicated cases, in which other variables can be involved in unfavourable outcomes. Methods Based on the safe profile of absorbable meshes, we have used meshes to reinforce the hiatoplasty in patients with theoretical higher risks of hernia recurrence. Twenty four patients were operated using bioabsorbable mesh (Gore Bio A®), implanted as an onlay inverted C over a completely closed hiatus. Two surgeons were responsible for all the surgeries. There were 16 (66,6%) women and 8 (33,3%) men. The main reasons for using a mesh were: primary large hiatal hernias (4 cm or more)—14 cases; redo hiatal hernias—8 cases; increased abdominal pressure—2 cases. Results All surgeries were performed between April 2018 and January 2020. Meshes were fixed to the diaphragm using absorbable sutures, fibrin sealant or cyanoacrylate. In all cases, a Nissen fundoplication was performed. There were no conversions. Two (8,3%) patients complained of troublesome dysphagia requiring intervention. One had to be operated within the first 48 hours after surgery: 2 stitches of the hiatus were removed and the fundoplication was converted into a Toupet. The other patient was submitted to endoscopic dilatation and still referes mild dysphagia. In a short follow up period (1–19 months), 23 patients (95,8%) are asymptomatic. Conclusion The use of bioabsorbable mesh in the hiatus is safe and have shown good symptomatic outcomes in the short follow up period. Objective results and longer follow up are needed to see if additional reinforcement of hiatoplasty contributes to reduce recurrence and reoperation rates.