Paraesophageal Hiatal Hernia Repair With Urinary Bladder Matrix Graft

Raelina S. Howell, Melissa Fazzari, Patrizio Petrone, Alexander Barkan, Keneth Hall, María José Servide, María Fernanda Anduaga, Collin E.M. Brathwaite

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and Objectives: Paraesophageal hiatal hernia repair can be performed with or without mesh reinforcement. The use, technique, and mesh type remain controversial because of mixed reports on mesh-related complications. Short-term outcomes have become important in all forms of surgery.

Methods: From January 2012 through April 2017, all patients who underwent isolated hiatal hernia repair in our center were reviewed. Concomitant bariatric surgery cases were excluded. Repairs reinforced by porcine urinary bladder matrix (UBM) graft were compared to non-UBM repairs. Statistical comparison was based on a Wilcoxon 2-sample test or Fisher's exact test.

Results: We reviewed 239 charts; 110 bariatric cases and 8 cases with non-UBM reinforcement were excluded. We identified 121 patients: 56 UBM-reinforced (46.3%) versus 65 non-UBM (53.7%). Sixteen (28.6%) UBM cases were male versus 23 (35.4%) non-UBM cases. The UBM patients were significantly older (63.9 versus 54.3; P = .001). There was no difference in mean BMI (29.6 vs 28.5; P = .28). Cases were performed laparoscopically (60.7% vs 67.7%; P = .45) or robotically (39.3% vs 32.3%; P = .45), with no conversions to open. The UBM group had a longer mean operative time (183 minutes vs 139 minutes; P = .001).There was no difference in median length of stay (2 days vs 2 days; P = .09) or 30-day readmission rate (7.1% vs 7.5%; P =.99). Postoperative complications were graded according to the Clavien-Dindo classification, and there was no difference (19.6% vs 9.2%; P = .12).

Conclusions: Hiatal hernia repair with UBM reinforcement can be performed safely with no increase in postoperative complications.

Original languageEnglish (US)
JournalJSLS : Journal of the Society of Laparoendoscopic Surgeons
Volume22
Issue number2
DOIs
StatePublished - Apr 1 2018
Externally publishedYes

Fingerprint

Hiatal Hernia
Herniorrhaphy
Urinary Bladder
Transplants
Bariatrics
Bariatric Surgery
Operative Time
Length of Stay
Swine

Keywords

  • Cruroplasty
  • Fundoplication
  • Mesh
  • Paraesophageal hiatal hernia
  • Urinary bladder matrix

ASJC Scopus subject areas

  • Surgery

Cite this

Paraesophageal Hiatal Hernia Repair With Urinary Bladder Matrix Graft. / Howell, Raelina S.; Fazzari, Melissa; Petrone, Patrizio; Barkan, Alexander; Hall, Keneth; Servide, María José; Anduaga, María Fernanda; Brathwaite, Collin E.M.

In: JSLS : Journal of the Society of Laparoendoscopic Surgeons, Vol. 22, No. 2, 01.04.2018.

Research output: Contribution to journalArticle

Howell, Raelina S. ; Fazzari, Melissa ; Petrone, Patrizio ; Barkan, Alexander ; Hall, Keneth ; Servide, María José ; Anduaga, María Fernanda ; Brathwaite, Collin E.M. / Paraesophageal Hiatal Hernia Repair With Urinary Bladder Matrix Graft. In: JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2018 ; Vol. 22, No. 2.
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abstract = "Background and Objectives: Paraesophageal hiatal hernia repair can be performed with or without mesh reinforcement. The use, technique, and mesh type remain controversial because of mixed reports on mesh-related complications. Short-term outcomes have become important in all forms of surgery.Methods: From January 2012 through April 2017, all patients who underwent isolated hiatal hernia repair in our center were reviewed. Concomitant bariatric surgery cases were excluded. Repairs reinforced by porcine urinary bladder matrix (UBM) graft were compared to non-UBM repairs. Statistical comparison was based on a Wilcoxon 2-sample test or Fisher's exact test.Results: We reviewed 239 charts; 110 bariatric cases and 8 cases with non-UBM reinforcement were excluded. We identified 121 patients: 56 UBM-reinforced (46.3{\%}) versus 65 non-UBM (53.7{\%}). Sixteen (28.6{\%}) UBM cases were male versus 23 (35.4{\%}) non-UBM cases. The UBM patients were significantly older (63.9 versus 54.3; P = .001). There was no difference in mean BMI (29.6 vs 28.5; P = .28). Cases were performed laparoscopically (60.7{\%} vs 67.7{\%}; P = .45) or robotically (39.3{\%} vs 32.3{\%}; P = .45), with no conversions to open. The UBM group had a longer mean operative time (183 minutes vs 139 minutes; P = .001).There was no difference in median length of stay (2 days vs 2 days; P = .09) or 30-day readmission rate (7.1{\%} vs 7.5{\%}; P =.99). Postoperative complications were graded according to the Clavien-Dindo classification, and there was no difference (19.6{\%} vs 9.2{\%}; P = .12).Conclusions: Hiatal hernia repair with UBM reinforcement can be performed safely with no increase in postoperative complications.",
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AU - Fazzari, Melissa

AU - Petrone, Patrizio

AU - Barkan, Alexander

AU - Hall, Keneth

AU - Servide, María José

AU - Anduaga, María Fernanda

AU - Brathwaite, Collin E.M.

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N2 - Background and Objectives: Paraesophageal hiatal hernia repair can be performed with or without mesh reinforcement. The use, technique, and mesh type remain controversial because of mixed reports on mesh-related complications. Short-term outcomes have become important in all forms of surgery.Methods: From January 2012 through April 2017, all patients who underwent isolated hiatal hernia repair in our center were reviewed. Concomitant bariatric surgery cases were excluded. Repairs reinforced by porcine urinary bladder matrix (UBM) graft were compared to non-UBM repairs. Statistical comparison was based on a Wilcoxon 2-sample test or Fisher's exact test.Results: We reviewed 239 charts; 110 bariatric cases and 8 cases with non-UBM reinforcement were excluded. We identified 121 patients: 56 UBM-reinforced (46.3%) versus 65 non-UBM (53.7%). Sixteen (28.6%) UBM cases were male versus 23 (35.4%) non-UBM cases. The UBM patients were significantly older (63.9 versus 54.3; P = .001). There was no difference in mean BMI (29.6 vs 28.5; P = .28). Cases were performed laparoscopically (60.7% vs 67.7%; P = .45) or robotically (39.3% vs 32.3%; P = .45), with no conversions to open. The UBM group had a longer mean operative time (183 minutes vs 139 minutes; P = .001).There was no difference in median length of stay (2 days vs 2 days; P = .09) or 30-day readmission rate (7.1% vs 7.5%; P =.99). Postoperative complications were graded according to the Clavien-Dindo classification, and there was no difference (19.6% vs 9.2%; P = .12).Conclusions: Hiatal hernia repair with UBM reinforcement can be performed safely with no increase in postoperative complications.

AB - Background and Objectives: Paraesophageal hiatal hernia repair can be performed with or without mesh reinforcement. The use, technique, and mesh type remain controversial because of mixed reports on mesh-related complications. Short-term outcomes have become important in all forms of surgery.Methods: From January 2012 through April 2017, all patients who underwent isolated hiatal hernia repair in our center were reviewed. Concomitant bariatric surgery cases were excluded. Repairs reinforced by porcine urinary bladder matrix (UBM) graft were compared to non-UBM repairs. Statistical comparison was based on a Wilcoxon 2-sample test or Fisher's exact test.Results: We reviewed 239 charts; 110 bariatric cases and 8 cases with non-UBM reinforcement were excluded. We identified 121 patients: 56 UBM-reinforced (46.3%) versus 65 non-UBM (53.7%). Sixteen (28.6%) UBM cases were male versus 23 (35.4%) non-UBM cases. The UBM patients were significantly older (63.9 versus 54.3; P = .001). There was no difference in mean BMI (29.6 vs 28.5; P = .28). Cases were performed laparoscopically (60.7% vs 67.7%; P = .45) or robotically (39.3% vs 32.3%; P = .45), with no conversions to open. The UBM group had a longer mean operative time (183 minutes vs 139 minutes; P = .001).There was no difference in median length of stay (2 days vs 2 days; P = .09) or 30-day readmission rate (7.1% vs 7.5%; P =.99). Postoperative complications were graded according to the Clavien-Dindo classification, and there was no difference (19.6% vs 9.2%; P = .12).Conclusions: Hiatal hernia repair with UBM reinforcement can be performed safely with no increase in postoperative complications.

KW - Cruroplasty

KW - Fundoplication

KW - Mesh

KW - Paraesophageal hiatal hernia

KW - Urinary bladder matrix

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