Repair of Large Hiatal Hernias With the Use of Mesh and Autologous Platelet-Rich Plasma.
Journal
Surgical laparoscopy, endoscopy & percutaneous techniques
ISSN: 1534-4908
Titre abrégé: Surg Laparosc Endosc Percutan Tech
Pays: United States
ID NLM: 100888751
Informations de publication
Date de publication:
20 Sep 2021
20 Sep 2021
Historique:
received:
04
07
2021
accepted:
24
08
2021
pubmed:
22
9
2021
medline:
8
2
2022
entrez:
21
9
2021
Statut:
epublish
Résumé
According to recent studies, large hiatal hernias (HH) can be associated with a lower content of type-I and type-III collagen in the phrenoesophageal ligament (POL). We therefore hypothesize that the use of a mesh implant with autologous platelet-rich plasma (PRP) for repair of large HH would have a positive effect on long-term outcome.The purpose of our study was to determine the level of type-I and type-III collagens in the POL of patients with large HH with the aim of improving the technique of HH repair. During the first phase of the study, the collagen content within the POL was assessed in 18 patients with HH and 14 cadaveric specimens without HH. During the second phase, 54 patients with large HH (defined as 10 to 20 cm2), that required surgery were recruited. Laparoscopic repair involved use of a nonabsorbable self-fixating ProGrip mesh infiltrated with 2 to 4 mL of autologous PRP was used for reinforcement of crural repair. Results were assessed using endoscopy, barium swallow, 24-hour impedance-pH monitoring and a quality of life gastroesophageal reflux disease-health related quality of life questionnaire. The content of collagen within POL in patients with HH was significantly lower than in the cadaveric specimens without HH. Of the 54 patients undergoing HH repair, all procedures were performed laparoscopically and there were no mortalities in this group. At 48 months, only 2 HH recurrences (3.7%) were detected. During this period, the mean gastroesophageal reflux disease-health related quality of life score decreased from 15.7±5.5 to 5.9±0.6 (P<0.05). Our study has shown that the collagen content is reduced in patients with large HH; thus, it is advisable to use mesh for HH repair in such patients. Use of mesh infiltrated in PRP is safe and can have positive impact on results of HH repair.
Sections du résumé
BACKGROUND
BACKGROUND
According to recent studies, large hiatal hernias (HH) can be associated with a lower content of type-I and type-III collagen in the phrenoesophageal ligament (POL). We therefore hypothesize that the use of a mesh implant with autologous platelet-rich plasma (PRP) for repair of large HH would have a positive effect on long-term outcome.The purpose of our study was to determine the level of type-I and type-III collagens in the POL of patients with large HH with the aim of improving the technique of HH repair.
MATERIALS AND METHODS
METHODS
During the first phase of the study, the collagen content within the POL was assessed in 18 patients with HH and 14 cadaveric specimens without HH. During the second phase, 54 patients with large HH (defined as 10 to 20 cm2), that required surgery were recruited. Laparoscopic repair involved use of a nonabsorbable self-fixating ProGrip mesh infiltrated with 2 to 4 mL of autologous PRP was used for reinforcement of crural repair. Results were assessed using endoscopy, barium swallow, 24-hour impedance-pH monitoring and a quality of life gastroesophageal reflux disease-health related quality of life questionnaire.
RESULTS
RESULTS
The content of collagen within POL in patients with HH was significantly lower than in the cadaveric specimens without HH. Of the 54 patients undergoing HH repair, all procedures were performed laparoscopically and there were no mortalities in this group. At 48 months, only 2 HH recurrences (3.7%) were detected. During this period, the mean gastroesophageal reflux disease-health related quality of life score decreased from 15.7±5.5 to 5.9±0.6 (P<0.05).
CONCLUSION
CONCLUSIONS
Our study has shown that the collagen content is reduced in patients with large HH; thus, it is advisable to use mesh for HH repair in such patients. Use of mesh infiltrated in PRP is safe and can have positive impact on results of HH repair.
Identifiants
pubmed: 34545035
doi: 10.1097/SLE.0000000000001004
pii: 00129689-202202000-00003
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
9-13Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Siegal SR, Dolan JP, Hunter JG. Modern diagnosis and treatment of hiatal hernias. Langenbecks Arch Surg. 2017;402:1145–1151.
Banki F, Kaushik C, Roife D, et al. Laparoscopic repair of large hiatal hernia without the need for esophageal lengthening with low morbidity and rare symptomatic recurrence. Semin Thorac Cardiovasc Surg. 2017;29:418–425.
Furnée E, Hazebroek E. Mesh in laparoscopic large hiatal hernia repair: a systematic review of the literature. Surg Endosc. 2013;27:3998–4008.
Castelijns PSS, Ponten JEH, van de Poll MCG, et al. A collective review of biological versus synthetic mesh-reinforced cruroplasty during laparoscopic Nissen fundoplication. J Minim Access Surg. 2018;14:87–94.
Huddy JR, Markar SR, Ni MZ, et al. Laparoscopic repair of hiatus hernia: Does mesh type influence outcome? A meta-analysis and European survey study. Surg Endosc. 2016;30:5209–5221.
Balagué C, Fdez-Ananín S, Sacoto D, et al. Paraesophageal hernia: to mesh or not to mesh? The controversy continues. J Laparoendosc Adv Surg Tech A. 2020;30:140–146.
Pfluke JM, Parker M, Bowers SP, et al. Use of mesh for hiatal hernia repair: a survey of SAGES members. Surg Endosc. 2012;26:1843–1848.
Ilyashenko VV, Grubnyk VV, Grubnik VV. Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair. Surg Endosc. 2018;32:3592–3598.
von Diemen V, Trindade EN, Trindade MRM. Hiatal hernia and gastroesophageal reflux: study of collagen in the phrenoesophageal ligament. Surg Endosc. 2016;30:5091–5098.
Altieri MS, Pagnotti G, Corthals A, et al. Autologous augmentation of hiatal hernia repair with filtered platelet concentrate improves tissue remodeling in a swine model. Surg Endosc. 2017;31:1591–1598.
Granderath FA, Schweiger UM, Pointner R. Laparoscopic antireflux surgery: tailoring the hiatal closure to the size of hiatal surface area. Surg Endosc. 2007;21:542–548.
El Sherif A, Yano F, Mittal S, et al. Collagen metabolism and recurrent hiatal hernia: cause and effect? Hernia. 2006;10:511–520.
Curci JA, Melman LM, Thompson RW, et al. Elastic fiber depletion in the supporting ligaments of the gastroesophageal junction: a structural basis for the development of hiatal hernia. J Am Coll Surg. 2008;207:191–196.
Asling B, Jirholt J, Hammond P, et al. Collagen type III alpha I is a gastro-oesophageal reflux disease susceptibility gene and a male risk factor for hiatus hernia. Gut. 2009;58:1063–1069.
Sathasivam R, Bussa G, Viswanath Y, et al. ‘Mesh hiatal hernioplasty’ versus ‘suture cruroplasty’ in laparoscopic para-oesophageal hernia surgery; a systematic review and meta-analysis. Asian J Surg. 2019;42:53–60.
Müller-Stich BP, Kenngott HG, Gondan M, et al. Use of mesh in laparoscopic paraesophageal hernia repair: a meta-analysis and risk-benefit analysis. PLoS One. 2015;10:e0139547.
Li J, Cheng T. Mesh erosion after hiatal hernia repair: the tip of the iceberg? Hernia. 2019;23:1243–1252.
Yatabe K, Ozawa S, Ito E, et al. Late esophageal wall injury after mesh repair for large esophageal hiatal hernia: a case report. Surg Case Rep. 2017;3:125.
Hamilton BH, Best TM. Platelet-enriched plasma and muscle strain injuries: challenges imposed by the burden of proof. Clin J Sports Med. 2011;21:31–36.
Wright-Carpenter T, Opolon P, Appell HJ, et al. Treatment of muscle injuries by local administration of autologous conditioned serum: animal experiments using a muscle contusion model. Int J Sports Med. 2004;25:582–587.
Van Eps J, Fernandez-Moure J, Cabrera F, et al. Decreased hernia recurrence using autologous platelet-rich plasma (PRP) with Strattice™ mesh in a rodent ventral hernia model. Surg Endosc. 2016;30:3239–3249.