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INTERIM ANALYSIS OF A RANDOMIZED CONTROL TRIAL EVALUATING THE EFFICACY OF PLATELET-RICH PLASMA TO REDUCE RECURRENCES AFTER LARGE PARAESOPHAGEAL HERNIA REPAIR
Ashley Tran
*, Luke R. Putnam, Katie Galvin, Caitlin C. Houghton, John C. Lipham
Keck Hospital of USC, Los Angeles, CA
Introduction: Hernia (HH) recurrence following paraesophageal hernia (PEH) repair is a common problem. Prior studies have shown a decrease in type 1 and type 3 collagen in the phrenoesophageal ligament of patients with large PEH, potentially contributing to weakened connective tissue at the hiatus and a higher risk of hernia recurrence. The use of autologous platelet-rich plasma (PRP) has been shown to improve healing in connective tissue diseases, so we hypothesized that the use of PRP in PEH repair may reduce the risk of hernia recurrence. Herein, we describe the interim results of a prospective, randomized control trial evaluating the role of PRP in PEH repair.
Methods: Adult patients with PEH ?5cm were randomly assigned to either the treatment or control groups. Both groups underwent minimally invasive PEH repair with mesh and partial fundoplication. In the treatment group, the mesh was soaked in PRP, and PRP was injected into the crural repair. Patients with >1 year of follow-up data were included in the analysis. Patient demographics, perioperative characteristics, pre- and post-operative GERD-HRQL scores, and recurrence rates were compared.
Results: A total of 60 patients (30 in each group) were included in this study. Average follow up was 12.2±3.9months. Treatment and control patients’ age (67.9±9.0 vs 64.6±9.7, p=0.097), preoperative BMI (28.1±4.5 vs 29.2±5.1 kg/m
2, p=0.413), and preoperative GERD-HRQL scores (19.0±11.8 vs 23.7±11.8, p=0.141) were similar. Operative time for the PRP patients was 20 minutes longer, on average (115.9±56.3 vs 95.3±39.7 minutes, p=0.124. GERD-HRQL scores were similar between groups (7.4±6.8 vs 4.3±4.0, p=0.475), and hernia recurrence rates were lower in the treatment group, although this was not statistically significant (20% vs 30%, p=0.552).
Conclusion: The use of PRP for large HH repair is safe and feasible and may be associated with lower hernia recurrence rates. Continuing the study to completion and considering a multicenter approach to increase the sample size may help to determine if PRP is indeed a viable modality for decreasing PEH recurrence rate.
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