The use of mesh implants in laparoscopic treatment of large hiatal hernias
DOI:
https://doi.org/10.11603/2414-4533.2020.3.11123Keywords:
hiatal hernia, mesh implants, cruroraphyAbstract
The aim of the work: to study the effectiveness of using various types of mesh implants in the treatment of patients with large hiatal hernia.
Materials and Methods. From January 2011 to September 2018, 187 patients with large hiatal hernias were operated in our clinic. The average age of patients was (57±14.9) (39 to 78 years). The average body mass index in the operated patients was (28.6±5.4) kg. All patients, depending on the method of hiatal hernia repair, were divided into 4 groups. In group I (54 patients), simple cruroraphy was performed. In group II (59 patients), a self-fixating ProGrip mesh was used to reinforcement the crural repair. In group III (49 patients), a Parietex mesh implant with a collagen coating was used. In group IV (25 patients), an absorbable Vicryl mesh implant was used. Long-term results were studied for 6, 12, 24, 36, 48, and 60 months after surgery. Patients underwent barium swallow study, upper endoscopy and 24-hour pH-metry with the calculation of the index DeMeester. All complaints were recorded in patients, the quality of life was determined according to the GERD-HRQL questionnaire.
Results and Discussion. All surgical interventions were performed laparoscopically without conversion to open surgery. In 10 patients, intraoperative complications were observed. In the long-term follow-up from 24 to 60 months, 74.87 % of the operated patients were examined. The number of recurrences after 60 months in the group with simple crurography was 26.3 %, which was significantly higher than in the groups where non-absorbable mesh ProGrip and Parietex implants were used (4.5 and 7.9 %, respectively). The group of patients with using absorbable Vicryl mesh showed worse results compared to the groups where non-absorbable meshes were used, the recurrence rate in this group was 20 %. After 48 months of follow-up, the Quality of Life Index was significantly higher in patients who used mesh implants. The DeMeester index in the group I of patients was 18.8 and was higher than in the groups of patients with mesh repair.
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