Different Biologic Grafts for Diaphragmatic Crura Reinforcement During Laparoscopic Repair of Large Hiatal Hernia: A Six-Year Single Surgeon Experience

Abstract

Background: Large hiatal hernias represent a challenge for surgeons. Biologic grafts are currently popular for the strengthening of crural closure during laparoscopic repair. This study is a retrospective review of crural reinforcement in laparoscopic repair of large hiatal hernias using various biologic grafts performed by a single surgeon in a rural community hospital. Methods: Eleven (n = 11) patients underwent laparoscopic repair of large hiatal hernia in a rural community hospital by a single surgeon from 2009 to 2015. Standard laparoscopic hiatal hernia repair was performed. Different biologic grafts were used for crural reinforcement, including “AlloMax”, “Permacol”, and “Acell MatriStem”. Perioperative data and outcomes of surgery were evaluated. Results: There were six females and five males, with a mean age of 55.4 years and a mean body mass index of 32.5. Eight patients had type III hiatal hernia, two patients had type IV, and one patient had type II. Mean operative time was 244.6 minutes, and mean length of stay was 3.3 days. Mean size of herniated stomach in the chest was 62%. Mean size of the hiatal defect was 7.7 × 6.4 cm. One perioperative complication (9%) included bleeding from left gastric artery. Early complications included shortness of breath (18%), parapneumonic effusion (18%), and early dysphagia (18%). Late complications included persistent gastroesophageal reflux (9%), gastroparesis (9%), and persistent dysphagia (9%). Radiological recurrence was 18% and clinical recurrence was 9% at mean follow-up of 15 months. Conclusions: Laparoscopic repair of large hiatal hernia could be safely performed in rural community hospitals. The choice of the biologic graft, if one is used, should be at the discretion of the surgeon. The cost and availability of the biologic graft are important in decision-making. J Curr Surg. 2016;6(1):6-13 doi: http://dx.doi.org/10.14740/jcs287w