A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia.

HYPOTHESIS Large hiatal hernias are prone to disruption, resulting in reherniation, when repaired with simple cruroplasty. The use of mesh may decrease the rate of reherniation in the laparoscopic repair of large hiatal hernias. DESIGN Prospective, randomized controlled trial. SETTING University-affiliated private hospital. PATIENTS Seventy-two individuals undergoing laparoscopic Nissen fundoplication with a hernia defect greater or equal to 8 cm in diameter. INTERVENTION Nissen fundoplication with posterior cruroplasty (n = 36) vs Nissen fundoplication with posterior cruroplasty and onlay of polytetrafluoroethylene (PTFE) mesh (n = 36). MAIN OUTCOME MEASURES Recurrences, complications, hospital stay, operative time, and cost. RESULTS Patients in both groups had similar hospital stays, but the PTFE group had a longer operative time. The cost of the repair was $960 +/- $70 more in the group with the prosthesis. Complications were minor and similar in both groups. There were 8 hernia recurrences (22%) in the primary repair group and none in the PTFE group (P<.006). CONCLUSION The use of prosthetic reinforcement of cruroplasty in large hiatal hernias may prevent hernia recurrences.

[1]  C. Frantzides,et al.  Laparoscopic repair of paraesophageal hiatal hernia , 2004, Surgical Endoscopy.

[2]  G. Kuster,et al.  Laparoscopic repair of paraesophageal hiatal hernias , 1993, Surgical Endoscopy.

[3]  D. Cloyd.  Laparoscopic repair of incarcerated paraesophageal hernias , 2004, Surgical Endoscopy.

[4]  A. Szold,et al.  Laparoscopic Repair of Paraesophageal Hernia with Selective Use of Mesh , 2003, Surgical laparoscopy, endoscopy & percutaneous techniques.

[5]  C. Frantzides,et al.  Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases. , 2001, Journal of the American College of Surgeons.

[6]  P. Schauer,et al.  Laparoscopic Repair of Giant Paraesophageal Hernia: 100 Consecutive Cases , 2000, Annals of surgery.

[7]  J. Jeekel,et al.  A comparison of suture repair with mesh repair for incisional hernia. , 2000, The New England journal of medicine.

[8]  J. Peters,et al.  Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. , 2000, Journal of the American College of Surgeons.

[9]  G. S. Smith,et al.  Esophagogastric fistula secondary to teflon pledget: a rare complication following laparoscopic fundoplication. , 2000, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus.

[10]  C. Frantzides,et al.  Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene , 1999, Surgical Endoscopy.

[11]  C. Frantzides,et al.  A study of 362 consecutive laparoscopic Nissen fundoplications. , 1998, Surgery.

[12]  M. Carlson,et al.  Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. , 1998, Journal of the American College of Surgeons.

[13]  C. Frantzides,et al.  Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy , 1997, Surgical Endoscopy.

[14]  Hunt Tr.  Laparoscopic mesh repair of the esophageal hiatus. , 1997 .

[15]  P. Petrucci,et al.  Laparoscopic tension-free repair of large paraesophageal hernias , 1997, Surgical Endoscopy.

[16]  T. R. Huntington.  Laparoscopic mesh repair of the esophageal hiatus. , 1997, Journal of the American College of Surgeons.

[17]  R. Schlinkert,et al.  Laparoscopic management of paraesophageal hernia: early results. , 1996, Journal of laparoendoscopic surgery.

[18]  K. Zucker,et al.  Successful laparoscopic repair of paraesophageal hernia. , 1995, Archives of surgery.

[19]  C. Frantzides,et al.  Laparoscopic versus conventional fundoplication. , 1995, Journal of laparoendoscopic surgery.

[20]  D. Edelman.  Laparoscopic paraesophageal hernia repair with mesh. , 1995, Surgical laparoscopy & endoscopy.

[21]  J. Hunter,et al.  Laparoscopic repair of paraesophageal hernia. New access, old technique. , 1995, Surgical endoscopy.

[22]  P. Johnson,et al.  Laparoscopic anterior gastropexy for treatment of paraesophageal hernias. , 1994, Surgical laparoscopy & endoscopy.

[23]  F. Harder,et al.  [Surgery in para-esophageal hiatal hernia: technic and results]. , 1989, Schweizerische medizinische Wochenschrift.

[24]  J. Bauer,et al.  Repair of large abdominal wall defects with expanded polytetrafluoroethylene (PTFE). , 1987, Annals of surgery.

[25]  M. Orringer,et al.  Surgical treatment after the failed antireflux operation. , 1986, The Journal of thoracic and cardiovascular surgery.

[26]  F. Ellis,et al.  Paraesophageal hiatus hernia. , 1986, Archives of surgery.

[27]  F. Cerny,et al.  Prosthetic materials and muscle flaps in the repair of extensive diaphragmatic defects: an experimental study. , 1985, Journal of pediatric surgery.

[28]  Robert J. Baker,et al.  Mastery of surgery , 1984 .

[29]  P. Parmeggiani,et al.  [Congenital diaphragmatic hernia]. , 1982, La Pediatria.

[30]  D. Sengupta,et al.  Congenital diaphragmatic hernia. , 1963, The Indian journal of child health.