Background: Previous studies have shown the repair of large paraesophageal hernias is associated with a high recurrence rate, when the surgery is approached laparoscopically and repair is made by simple cruroplasty. Anatomic recurrence due to crura breakdown is a primary etiology. Synthetic mesh has been reported to cause esophageal erosions. The aim of this study is to analyze our results of cruroplasty reinforcement with human acellular dermal matrix in large hiatal hernia repair.
Methods and Material: This is a retrospective study in a university setting. Between March/2005 and November/2006, 41 patients underwent laparoscopic repair of large hiatal hernia with reinforcement of cruroplasty by using human acellular dermal matrix.Data were collected using patient charts and radiographic reports. The variables analyzed, were age, sex, follow up, weight, height, hiatal hernia size, operative time, hospital stay, complications (erosion, infection, pneumotorax and wrap migration) and recurrence.
Results: Current median follow-up available on 41 patients (20 male; 21 female) was 14 months (range 1-20 month). Mean age was 57.3 (range 34 -75 years). Mean weight (kg) and height (cm) were 87.9 (range 63-114) and 173 (range 156-185). Means of hernia size (cm) was 5.75 (range 3-10), operative time was 121 (range 75 - 235) min, hospital stay was 1.36 (range 1-3) days. Complication 2.7% (pneumotorax n= 1) and recurrence of 2.7% (n= 1).
Conclusion: Laparoscopic hiatal hernia repair with reinforcement of human acellular dermal matrix can be performed safely with low rate of complications, a short hospital length of stay and a low rate of recurrence. This procedure provides a durable and effective method of repairing a large paraesophageal hiatal hernia with low morbidity and mortality.