Evaluation of DualMesh for repair of large hiatus hernia in a porcine model

• Published in: Surgical endoscopy Vol. 22; no. 7; pp. 1625 - 1631
• Main Authors: Smith, G. S., Hazebroek, E. J., Eckstein, R., Berry, H., Smith, W. M., Isaacson, J. R., Falk, G. L., Martin, C. J.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-07-2008; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Abdominal Wall - pathology; Animals; Biological and medical sciences; Digestive system. Abdomen; Disease Models, Animal; Endoscopy; Esophagogastric Junction - pathology; Gastroenterology; General aspects; Gynecology; Hepatology; Hernia, Hiatal - surgery; Investigative techniques, diagnostic techniques (general aspects); Medical sciences; Medicine; Medicine & Public Health; Miscellaneous; Proctology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Surgery; Surgical Mesh - adverse effects; Swine; Thoracotomy - adverse effects; Thoracotomy - instrumentation; Tissue Adhesions - etiology; Tissue Adhesions - pathology; Treatment Failure; Treatment Outcome; Hiatus hernia; Porcine; Laparoscopic; Mesh repair; Endoscopic surgery; Laparoscopy; Pig; Medicine; Vertebrata; Mammalia; Treatment; Digestive diseases; Models; Artiodactyla; Endoscopy; Repair; Ungulata; Gastric disease
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-007-9669-y

Background
Prosthetic fascial grafts are frequently used for augmentation of cruroplasty in large hiatus hernia repair to decrease the chances of recurrence. Potential complications such as intraluminal erosion may be related to the constant movement of mesh and diaphragm over the outer surface of the esophagus. This study aimed to evaluate DualMesh for repair of large hiatal defects in a porcine model.
Methods
In this study, 18 Landrace × large white × Duroc crossbred pigs underwent either primary hiatal repair or tension-free prosthetic repair using DualMesh (80 × 50 mm or 80 × 100 mm). The animals were killed at 3 or 28 weeks for macroscopic and histologic evaluation of the hiatal region and gastroesophageal junction.
Results
All grafts had become encapsulated at 28 weeks, and the majority had filmy adhesions only to the visceral aspect. In all models, the esophagus moved freely over the cut edge of the prosthesis. No signs of intraluminal erosion were documented. At histologic examination, significant ingrowth was noted on the porous side of the mesh, whereas no defined mesothelial layer was identified on the capsule of the nonporous side.
Conclusion
In this animal model of large hiatus hernia repair, DualMesh showed optimal characteristics in terms of host tissue incorporation on the porous side and absence of adhesions on the visceral side of the prosthesis. The absence of adhesions and intraluminal erosion in this study may provide reassurance to surgeons using mesh at the hiatus.