Diaphragmatic crural augmentation utilising cross-linked porcine dermal collagen biologic mesh (Permacol) in the repair of large and complex para-oesophageal herniation: a retrospective cohort study

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Hdl Handle:
http://hdl.handle.net/11287/594036
Title:
Diaphragmatic crural augmentation utilising cross-linked porcine dermal collagen biologic mesh (Permacol) in the repair of large and complex para-oesophageal herniation: a retrospective cohort study
Authors:
Travers, H. C.; Brewer, James O.; Smart, Neil J. ( 0000-0002-3043-8324 ) ; Wajed, Shahjehan A.
Abstract:
OBJECTIVE: To evaluate the safety, efficacy and durability of selective integration of porcine dermal collagen (Permacol) biologic mesh for crural re-construction in large or complex para-oesophageal hernia surgery. BACKGROUND: Surgical repair of para-oesophageal herniation has been associated with high rates of failure. The utilisation of prosthetic mesh is controversial with complications including erosion and fistulation. Long-term outcomes for biologic mesh crural augmentation are unclear. METHODS: A retrospective analysis of patients who underwent a biologic mesh (PermacolTM) augmented cruroplasty in the repair of large and/or complex para-oesophageal hernia was performed utilising the prospectively maintained oesophago-gastric database at the Royal Devon and Exeter Hospital between October 2004 and January 2013. This technique was selectively used for patients where the lateral extent of the diaphragmatic-crural defect prevented the fashioning of a sound, tension-free repair with sutures alone, or previous surgery had failed. Successful outcome was defined by resolution of symptoms and structural integrity of the repair. RESULTS: Fifty one procedures were performed on 49 patients (15 male), median age 75 (range 25-91). Post-operative morbidity included 2 (3.9 %) oesophageal injuries managed conservatively, and 2 (3.9 %) patients who suffered early repair breakdown requiring immediate surgical re-intervention. Four patients (8 %) required endoscopic dilatation due to dysphagia, one (2 %) in the early post-operative phase. The median follow-up was 36 months (range 6-105). All patients reported initial symptomatic resolution. Two patients (4 %) were demonstrated to have breakdown of their repair during the follow-up period, both of whom underwent revision mesh-augmented surgery and are re-incorporated in this series. Late-onset dysphagia in two (4 %) patients may be mesh-related, but no other complications were observed and a Kaplan-Meier analysis of this series predicts a symptom-free rate of approximately 94 % at 5 years. CONCLUSIONS: The selective integration of biologic mesh to augment the crural repair in para-oesophageal hernia with extensive diaphragmatic defects appears to be safe, effective and infers the potential of long-term satisfactory outcomes.
Citation:
Hernia. 2016 Apr;20(2):311-20
Publisher:
Springer
Journal:
Hernia : the journal of hernias and abdominal wall surgery
Issue Date:
1-May-2015
URI:
http://hdl.handle.net/11287/594036
DOI:
10.1007/s10029-015-1390-5
PubMed ID:
25952981
Additional Links:
http://dx.doi.org/10.1007/s10029-015-1390-5
Type:
Journal Article
Language:
Eng
ISSN:
1248-9204
Appears in Collections:
2015 RD&E publications; Upper Gastro-Intestinal Surgery; HeSRU publications

Full metadata record

DC FieldValue Language
dc.contributor.authorTravers, H. C.en
dc.contributor.authorBrewer, James O.en
dc.contributor.authorSmart, Neil J.en
dc.contributor.authorWajed, Shahjehan A.en
dc.date.accessioned2016-01-19T12:38:53Zen
dc.date.available2016-01-19T12:38:53Zen
dc.date.issued2015-05-01en
dc.identifier.citationHernia. 2016 Apr;20(2):311-20en
dc.identifier.issn1248-9204en
dc.identifier.pmid25952981en
dc.identifier.doi10.1007/s10029-015-1390-5en
dc.identifier.urihttp://hdl.handle.net/11287/594036en
dc.description.abstractOBJECTIVE: To evaluate the safety, efficacy and durability of selective integration of porcine dermal collagen (Permacol) biologic mesh for crural re-construction in large or complex para-oesophageal hernia surgery. BACKGROUND: Surgical repair of para-oesophageal herniation has been associated with high rates of failure. The utilisation of prosthetic mesh is controversial with complications including erosion and fistulation. Long-term outcomes for biologic mesh crural augmentation are unclear. METHODS: A retrospective analysis of patients who underwent a biologic mesh (PermacolTM) augmented cruroplasty in the repair of large and/or complex para-oesophageal hernia was performed utilising the prospectively maintained oesophago-gastric database at the Royal Devon and Exeter Hospital between October 2004 and January 2013. This technique was selectively used for patients where the lateral extent of the diaphragmatic-crural defect prevented the fashioning of a sound, tension-free repair with sutures alone, or previous surgery had failed. Successful outcome was defined by resolution of symptoms and structural integrity of the repair. RESULTS: Fifty one procedures were performed on 49 patients (15 male), median age 75 (range 25-91). Post-operative morbidity included 2 (3.9 %) oesophageal injuries managed conservatively, and 2 (3.9 %) patients who suffered early repair breakdown requiring immediate surgical re-intervention. Four patients (8 %) required endoscopic dilatation due to dysphagia, one (2 %) in the early post-operative phase. The median follow-up was 36 months (range 6-105). All patients reported initial symptomatic resolution. Two patients (4 %) were demonstrated to have breakdown of their repair during the follow-up period, both of whom underwent revision mesh-augmented surgery and are re-incorporated in this series. Late-onset dysphagia in two (4 %) patients may be mesh-related, but no other complications were observed and a Kaplan-Meier analysis of this series predicts a symptom-free rate of approximately 94 % at 5 years. CONCLUSIONS: The selective integration of biologic mesh to augment the crural repair in para-oesophageal hernia with extensive diaphragmatic defects appears to be safe, effective and infers the potential of long-term satisfactory outcomes.en
dc.language.isoEngen
dc.publisherSpringeren
dc.relation.urlhttp://dx.doi.org/10.1007/s10029-015-1390-5en
dc.titleDiaphragmatic crural augmentation utilising cross-linked porcine dermal collagen biologic mesh (Permacol) in the repair of large and complex para-oesophageal herniation: a retrospective cohort studyen
dc.typeJournal Articleen
dc.identifier.journalHernia : the journal of hernias and abdominal wall surgeryen
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