Abstract
IntroductionA non-cross-linked porcine acellular dermal matrix was used to reinforce an esophageal hiatal hernia repair. A second surgery was required 11 months later to repair a slipped Nissen; this allowed for examination of the hiatal hernia repair and showed the graft to be well vascularized and fully incorporated.Case presentationA 71-year-old Caucasian woman presented with substernal burning and significant dysphagia. An upper gastrointestinal series revealed a type III complex paraesophageal hiatal hernia. She underwent laparoscopic surgery to repair a hiatal hernia that was reinforced with a xenograft (Strattice™ Reconstructive Tissue Matrix, LifeCell, Branchburg, NJ, USA) along with a Nissen fundoplication. A second surgery was required to repair a slipped Nissen; this allowed for examination of the hiatal repair and graft incorporation 11 months after the initial surgery.ConclusionIn this case, a porcine acellular dermal matrix was an effective tool to reinforce the crural hiatal hernia repair. The placement of the mesh and method of fixation are believed to be crucial to the success of the graft. It was found to be well vascularized 11 months after the original placement with no signs of erosion, stricture, or infection. Further studies and long-term follow-up are required to support the findings of this case report.
Highlights
A non-cross-linked porcine acellular dermal matrix was used to reinforce an esophageal hiatal hernia repair
Surgery is usually recommended for types II, III, and IV hiatal hernias
Synthetic meshes used for hiatal hernia repair are permanent and non-absorbable whereas biological meshes are integrated into the body
Summary
Acellular tissue matrices have been shown to be safe and effective for abdominal wall repair. There is a paucity of data on the long-term outcomes of biological grafts at the esophageal hiatus they have been successful at lowering the rate of recurrence in the short term. This case report shows that in this case the non-cross-linked PADM did reinforce the hiatal hernia repair without additional mesh-related complications. Proper technique when placing the graft is important: good overlay, efficient tissue apposition, and placing the graft in a non-circumferential manner are essential to a successful reinforcement of the primary hiatal repair. More studies are needed to support the claim that there are long-term benefits to this approach to hiatal hernia repair and use of non-cross-linked PADMs in this application. Competing interests The author declares that there are no competing interests
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