Platelet-Rich Plasma in Large Paraesophageal Hernia Repair: A Feasibility Study

Abstract

Background: The Achilles heel of antireflux surgery is hiatal hernia recurrence, and no treatment modalities to date have improved this outcome. Platelet-rich plasma (PRP) is an autologous therapy that promotes wound healing by upregulating extracellular matrix proteins, and it has excellent results in numerous surgical fields. Animal studies evaluating PRP use in hiatal hernia repair show favorable outcomes, yet its application in hiatal hernia repair in humans has not been described. Methods: This is a feasibility study of patients with large (>5 cm) paraesophageal hernia (PEH) who underwent PEH repair with PRP from 2/2021 to 1/2022. Safety, feasibility, and postoperative outcomes were investigated. Results: PRP was successfully administered during PEH repair in 12 consecutive patients. There were no significant adverse events. The methods for applying PRP to the repair were modified several times to optimize the technique. Administering PRP added an average of 5 minutes to the operative time. There were no significant postoperative complications or hernia recurrence on diagnostic imaging at latest follow up, with good subjective reflux control. Conclusion: PRP has excellent clinical outcomes in other surgical fields and may become an important new adjunct in antireflux surgery. This study shows PRP is safe and feasible in PEH repair, with little effect on operative time.