Medium term (> 12 months) outcomes after laparoscopic hiatal hernia repair without conventional fundoplication using PH4B‑mesh implant (Phasix™) in 176 reflux patients: experience and technique

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Item Type:	Article
Title:	Medium term (> 12 months) outcomes after laparoscopic hiatal hernia repair without conventional fundoplication using PH4B‑mesh implant (Phasix™) in 176 reflux patients: experience and technique
Creators Name:	Siemssen, B., Dahlke, P.M., Behrens, F., Hentschel, F. and Ibach, M.J.
Abstract:	BACKGROUND: Hiatal mesh repair remains a controversial topic among anti-reflux surgeons. Biosynthetic mesh cruroplasty may prevent early recurrence while avoiding late esophageal erosion and strictures associated with non-resorbable materials. So far, medium-term results on hiatal PH4B (Poly-4-Hydroxybutyrate) mesh repair from high-volume centers are lacking. METHODS: We analyzed the medium-term efficacy and safety of PH4B mesh cruroplasty in 176 consecutive patients (≥ 18 years) with symptomatic hiatal hernias. Treatment failure was defined as the clinical recurrence of reflux symptoms. Patients could choose between mesh augmented hiatal repair (combined with a modified anterior hemifundoplication and fundophrenicopexy), Nissen fundoplication, and magnetic sphincter augmentation at their discretion. We also describe the surgical approach to mesh augmented hiatal repair used at our center. RESULTS: On average, patients were 55 (± 14) years old and followed up for 22 (± 7; sum: 3931) months. Treatment failed in 6/176 (3%, 95% CI: 2–7%) patients. The 24-month Kaplan–Meier failure estimate was 2.8% (95% CI: 0.4–5%). Each centimeter in hernia size increased the risk of failure by 52% (p = 0.02). Heavier patients (BMI > 27) had an 11% higher probability of clinical symptom recurrence (p = 0.03). The dysphagia and bloating/gas rate were 13/176 (7%), each. 8 (5%) patients required endoscopy due to dysphagia but without intervention. No serious complications, including mesh infection and erosion, or fatalities, occurred. CONCLUSION: Augmented PH4B mesh cruroplasty without conventional fundoplication shows excellent intermediate-term results in patients with reflux disease due to hiatal hernia. Around one in thirty patients experience treatment failure within 2 years of surgery. Hernia size and overweight are key determinants of treatment failure.
Keywords:	Gastroesophageal Reflux Disease, Hiatus Hernia, Phasix(TM), PH4B, Cruroplasty, Fundoplication
Source:	Hernia
ISSN:	1265-4906
Publisher:	Springer
Volume:	28
Number:	5
Page Range:	1641-1647
Date:	October 2024
Official Publication:	https://doi.org/10.1007/s10029-024-02999-w
PubMed:	View item in PubMed

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