SSAT - SYMPTOMATIC, RADIOGRAPHIC, AND QUALITY OF LIFE OUTCOMES AFTER PARAEOPHAGEAL HERNIA REPAIR WITH MATRISTEM SURGICAL MATRIX

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SYMPTOMATIC, RADIOGRAPHIC, AND QUALITY OF LIFE OUTCOMES AFTER PARAEOPHAGEAL HERNIA REPAIR WITH MATRISTEM SURGICAL MATRIX
Chloe Q. Wang^*, Thanh Tran, Beth Montera, Rachel Karlnoski, Vic Velanovich
Surgery, University of South Florida, Tampa, FL

Background: Paraesophageal hernia is a condition in which the stomach and possibly other visceral organs herniate through a defect in the esophageal hiatus into the posterior mediastinum. Repair is recommended for patients with symptoms related to the hernia. However, recurrences are common with up to 50% of patients having radiographic or symptomatic recurrences. Mesh has been used to decrease recurrence rates. However, prosthetic meshes have been associated with complications such as mesh erosion and stricture formation. Biologic meshes have been used to reduce such complications, but they have been associated with higher recurrence rates. Urinary bladder matrix, MatriStem Surgical Matrix (ACell) mesh, provides a micro-environmental niche that alters the default healing response towards constructive and functional tissue deposition by the body. We hypothesized the use of ACell mesh in the repair of paraesophageal hernias would reduce both symptomatic and radiographic hernia recurrences.
Methods: This is a systematic follow-up of 20 pre-existing patients who have undergone paraesophageal hernia repair (PEHR) with ACell mesh by the same surgeon between October 2012 and May 2015. Patients returned for a one time follow up visit to assess for hernia recurrence both based on symptoms and radiographic evidence. The primary objective was to assess hernia recurrence at least 12 months post-PEHR. This is determined based on the follow up esophagogram with a greatest vertical height of the stomach measuring more than 2 cm above the diaphragm. The secondary objective was to assess symptomatic recurrence, complications, and quality of life at least 12 months post-PEHR. Patients were asked to answer GERD Health Related Quality of Life Questionnaires (HRQL) and post-operative Quality of Life Questionnaires. All statistical analysis was done using SAS 9.4 statistical software. Data were analyzed using nonparametric test and linear regression analysis.
Results: The average age was 70.31 � 7.29 years (range 56-87). Seventy percent were female. Four patients (20%) had radiographic evidence of hernia recurrence. Patients who were satisfied with their condition had a median HRQL score of 7 and those who were dissatisfied had a median score of 12 (p = 0.1706). Patient responses to the health transition item were: 35% for 1 (much better now than 1 year ago), 15% for 2 (somewhat better now than 1 year ago), and 50% for 3 (about the same as 1 year ago). None responded with 4 (somewhat worse now than 1 year ago) or 5 (much worse now than 1 year ago).
Conclusion: Based on our preliminary data, the use of ACell mesh in PEHR reduces radiographic recurrences of paraesophageal hernias, and improves quality of life post-PEHR.

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