A 3D totally absorbable synthetic mesh in antireflux surgery: Gore Bio-A tissue reinforcement for hiatal hernia repairing

Giorgio Romano, Giuseppe Di Buono, Antonino Agrusa, Sebastiano Bonventre, Gaspare Gulotta, Angela Inviati, Daniela Chianetta, Giovanni De Vita, Giuseppe Frazzetta, Silvia Di Giovanni

Research output: Contribution to journalBook/Film/Article review

Abstract

IntroductionHiatal hernia, defined as “transitory or stable dislocation of a part of the stomach in mediastinum through the diaphragmatic crura delimiting esophageal hiatus”. Its appearance presupposes anatomic anomalies or weakening of structures and mechanisms able to maintain esophago-gastric junction and stomach in the abdominal cavity [1]. Classically hiatal hernia was classified in four types using Hill’s classification: Type 1 hiatal hernia is associated with GERD in 50-90% of cases, in facts its presence gradually compromises esophago-gastric junction’s continence favouriting the backwater of acid secretion and its reflux in contact with esophageal mucosa during transient relaxations of the LES and also reducing clearing systems overall for large hiatal hernias [2, 3]. Several randomized controlled trials with long-term follow-up comparing surgical with medical therapy for the treatment of GERD, strongly support surgery as an effective alternative to medical therapy [4]. Fundoplication has also been demonstrated to lead to improved or at least comparable quality of life to that of medically treated patients and it is associated with high patients satisfactions rate [5]. A laparoscopic total fundoplication is considered today the procedure of choice increasing the resting pressure and length of the lower esophageal sphincter, decreasing the number of transient LES relaxations and improving quality of esophageal peristalsis and follow-up demonstrates complete symptoms control in 80-90% of patients 10 years later [6]. However primary laparoscopic hiatal hernia repair is associated with up 42% recurrence rate [7]. Several level data suggest that mesh reinforcement of the crural closure for hiatal hernia repair decreases the recurrence of hernia, but can lead to esophageal erosion and stenosis or disphagya, above all non-absorbable mesh [8, 9]. For this clinical case, we experiment a new totally absorbable Gore Bio-A® mesh [10]. Materials and methods: Clinical CaseFemale patient; 65-year old; 6-year classic history of GERD (regurgitation, belching, bloating, “acid in the throat” treated for several years by multiple proton pump inhibitors); BMI 22. An EGDS revealed a > 3 cm hiatal hernia, grade B Los Angeles esophagitis. 24-hour pH study was positive for acid reflux and esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic 5-trocars approach, the hiatal hernia defect was identified and primarily repaired, by crural closure, with size 0 permanent suture (ETHIBOND). GORE BIO-A® Tissue Reinforcement was trimmed to fit the defect with a “U” shape cutout to accommodate the esophagus. It was secured using two absorbable sutures (VICYRL). At least A Nissen fundoplication was performed without incident. Result: Gore BIO-A® mesh was easily placed through a 10-12 mm trocar. It had good handling characteristics laparoscopically, and no pre-operative preparation was required of the prosthetic. It can be cut and tailored intraoperatively to an optimal adaptation. There were no short-term complications from the mesh. The patient had not significant post-operative sequelae. ConclusionCrural closure reinforcement during hiatal hernia repair can be done readily with this new totally absorbable Gore Bio A Tissue Reinforcement: it is a 3D web of completely absorbable synthetic polymers replaced by soft tissue over six months; it is a mix of glycolic acid and trimethylene carbonate and its function consistes in stimulating collagens deposition and ingrowth of new connective soft tissue [11]. It was demonstrated that G
Original languageEnglish
Pages (from-to)19-20
Number of pages2
JournalJOURNAL OF BIOLOGICAL RESEARCH
Volume88
Publication statusPublished - 2015

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hiatal hernia
Hiatal Hernia
Surgery
Reinforcement
surgery
Tissue
Repair
glycolic acid
esophageal sphincter
Gastroesophageal Reflux
Fundoplication
Acids
Herniorrhaphy
Stomach
Defects
hernia
Proton Pump Inhibitors
sutures
Hernia
Prosthetics

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Plant Science
  • Biochemistry, medical

Cite this

A 3D totally absorbable synthetic mesh in antireflux surgery: Gore Bio-A tissue reinforcement for hiatal hernia repairing. / Romano, Giorgio; Di Buono, Giuseppe; Agrusa, Antonino; Bonventre, Sebastiano; Gulotta, Gaspare; Inviati, Angela; Chianetta, Daniela; De Vita, Giovanni; Frazzetta, Giuseppe; Di Giovanni, Silvia.

In: JOURNAL OF BIOLOGICAL RESEARCH, Vol. 88, 2015, p. 19-20.

Research output: Contribution to journalBook/Film/Article review

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abstract = "IntroductionHiatal hernia, defined as “transitory or stable dislocation of a part of the stomach in mediastinum through the diaphragmatic crura delimiting esophageal hiatus”. Its appearance presupposes anatomic anomalies or weakening of structures and mechanisms able to maintain esophago-gastric junction and stomach in the abdominal cavity [1]. Classically hiatal hernia was classified in four types using Hill’s classification: Type 1 hiatal hernia is associated with GERD in 50-90{\%} of cases, in facts its presence gradually compromises esophago-gastric junction’s continence favouriting the backwater of acid secretion and its reflux in contact with esophageal mucosa during transient relaxations of the LES and also reducing clearing systems overall for large hiatal hernias [2, 3]. Several randomized controlled trials with long-term follow-up comparing surgical with medical therapy for the treatment of GERD, strongly support surgery as an effective alternative to medical therapy [4]. Fundoplication has also been demonstrated to lead to improved or at least comparable quality of life to that of medically treated patients and it is associated with high patients satisfactions rate [5]. A laparoscopic total fundoplication is considered today the procedure of choice increasing the resting pressure and length of the lower esophageal sphincter, decreasing the number of transient LES relaxations and improving quality of esophageal peristalsis and follow-up demonstrates complete symptoms control in 80-90{\%} of patients 10 years later [6]. However primary laparoscopic hiatal hernia repair is associated with up 42{\%} recurrence rate [7]. Several level data suggest that mesh reinforcement of the crural closure for hiatal hernia repair decreases the recurrence of hernia, but can lead to esophageal erosion and stenosis or disphagya, above all non-absorbable mesh [8, 9]. For this clinical case, we experiment a new totally absorbable Gore Bio-A{\circledR} mesh [10]. Materials and methods: Clinical CaseFemale patient; 65-year old; 6-year classic history of GERD (regurgitation, belching, bloating, “acid in the throat” treated for several years by multiple proton pump inhibitors); BMI 22. An EGDS revealed a > 3 cm hiatal hernia, grade B Los Angeles esophagitis. 24-hour pH study was positive for acid reflux and esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic 5-trocars approach, the hiatal hernia defect was identified and primarily repaired, by crural closure, with size 0 permanent suture (ETHIBOND). GORE BIO-A{\circledR} Tissue Reinforcement was trimmed to fit the defect with a “U” shape cutout to accommodate the esophagus. It was secured using two absorbable sutures (VICYRL). At least A Nissen fundoplication was performed without incident. Result: Gore BIO-A{\circledR} mesh was easily placed through a 10-12 mm trocar. It had good handling characteristics laparoscopically, and no pre-operative preparation was required of the prosthetic. It can be cut and tailored intraoperatively to an optimal adaptation. There were no short-term complications from the mesh. The patient had not significant post-operative sequelae. ConclusionCrural closure reinforcement during hiatal hernia repair can be done readily with this new totally absorbable Gore Bio A Tissue Reinforcement: it is a 3D web of completely absorbable synthetic polymers replaced by soft tissue over six months; it is a mix of glycolic acid and trimethylene carbonate and its function consistes in stimulating collagens deposition and ingrowth of new connective soft tissue [11]. It was demonstrated that G",
author = "Giorgio Romano and {Di Buono}, Giuseppe and Antonino Agrusa and Sebastiano Bonventre and Gaspare Gulotta and Angela Inviati and Daniela Chianetta and {De Vita}, Giovanni and Giuseppe Frazzetta and {Di Giovanni}, Silvia",
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TY - JOUR

T1 - A 3D totally absorbable synthetic mesh in antireflux surgery: Gore Bio-A tissue reinforcement for hiatal hernia repairing

AU - Romano, Giorgio

AU - Di Buono, Giuseppe

AU - Agrusa, Antonino

AU - Bonventre, Sebastiano

AU - Gulotta, Gaspare

AU - Inviati, Angela

AU - Chianetta, Daniela

AU - De Vita, Giovanni

AU - Frazzetta, Giuseppe

AU - Di Giovanni, Silvia

PY - 2015

Y1 - 2015

N2 - IntroductionHiatal hernia, defined as “transitory or stable dislocation of a part of the stomach in mediastinum through the diaphragmatic crura delimiting esophageal hiatus”. Its appearance presupposes anatomic anomalies or weakening of structures and mechanisms able to maintain esophago-gastric junction and stomach in the abdominal cavity [1]. Classically hiatal hernia was classified in four types using Hill’s classification: Type 1 hiatal hernia is associated with GERD in 50-90% of cases, in facts its presence gradually compromises esophago-gastric junction’s continence favouriting the backwater of acid secretion and its reflux in contact with esophageal mucosa during transient relaxations of the LES and also reducing clearing systems overall for large hiatal hernias [2, 3]. Several randomized controlled trials with long-term follow-up comparing surgical with medical therapy for the treatment of GERD, strongly support surgery as an effective alternative to medical therapy [4]. Fundoplication has also been demonstrated to lead to improved or at least comparable quality of life to that of medically treated patients and it is associated with high patients satisfactions rate [5]. A laparoscopic total fundoplication is considered today the procedure of choice increasing the resting pressure and length of the lower esophageal sphincter, decreasing the number of transient LES relaxations and improving quality of esophageal peristalsis and follow-up demonstrates complete symptoms control in 80-90% of patients 10 years later [6]. However primary laparoscopic hiatal hernia repair is associated with up 42% recurrence rate [7]. Several level data suggest that mesh reinforcement of the crural closure for hiatal hernia repair decreases the recurrence of hernia, but can lead to esophageal erosion and stenosis or disphagya, above all non-absorbable mesh [8, 9]. For this clinical case, we experiment a new totally absorbable Gore Bio-A® mesh [10]. Materials and methods: Clinical CaseFemale patient; 65-year old; 6-year classic history of GERD (regurgitation, belching, bloating, “acid in the throat” treated for several years by multiple proton pump inhibitors); BMI 22. An EGDS revealed a > 3 cm hiatal hernia, grade B Los Angeles esophagitis. 24-hour pH study was positive for acid reflux and esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic 5-trocars approach, the hiatal hernia defect was identified and primarily repaired, by crural closure, with size 0 permanent suture (ETHIBOND). GORE BIO-A® Tissue Reinforcement was trimmed to fit the defect with a “U” shape cutout to accommodate the esophagus. It was secured using two absorbable sutures (VICYRL). At least A Nissen fundoplication was performed without incident. Result: Gore BIO-A® mesh was easily placed through a 10-12 mm trocar. It had good handling characteristics laparoscopically, and no pre-operative preparation was required of the prosthetic. It can be cut and tailored intraoperatively to an optimal adaptation. There were no short-term complications from the mesh. The patient had not significant post-operative sequelae. ConclusionCrural closure reinforcement during hiatal hernia repair can be done readily with this new totally absorbable Gore Bio A Tissue Reinforcement: it is a 3D web of completely absorbable synthetic polymers replaced by soft tissue over six months; it is a mix of glycolic acid and trimethylene carbonate and its function consistes in stimulating collagens deposition and ingrowth of new connective soft tissue [11]. It was demonstrated that G

AB - IntroductionHiatal hernia, defined as “transitory or stable dislocation of a part of the stomach in mediastinum through the diaphragmatic crura delimiting esophageal hiatus”. Its appearance presupposes anatomic anomalies or weakening of structures and mechanisms able to maintain esophago-gastric junction and stomach in the abdominal cavity [1]. Classically hiatal hernia was classified in four types using Hill’s classification: Type 1 hiatal hernia is associated with GERD in 50-90% of cases, in facts its presence gradually compromises esophago-gastric junction’s continence favouriting the backwater of acid secretion and its reflux in contact with esophageal mucosa during transient relaxations of the LES and also reducing clearing systems overall for large hiatal hernias [2, 3]. Several randomized controlled trials with long-term follow-up comparing surgical with medical therapy for the treatment of GERD, strongly support surgery as an effective alternative to medical therapy [4]. Fundoplication has also been demonstrated to lead to improved or at least comparable quality of life to that of medically treated patients and it is associated with high patients satisfactions rate [5]. A laparoscopic total fundoplication is considered today the procedure of choice increasing the resting pressure and length of the lower esophageal sphincter, decreasing the number of transient LES relaxations and improving quality of esophageal peristalsis and follow-up demonstrates complete symptoms control in 80-90% of patients 10 years later [6]. However primary laparoscopic hiatal hernia repair is associated with up 42% recurrence rate [7]. Several level data suggest that mesh reinforcement of the crural closure for hiatal hernia repair decreases the recurrence of hernia, but can lead to esophageal erosion and stenosis or disphagya, above all non-absorbable mesh [8, 9]. For this clinical case, we experiment a new totally absorbable Gore Bio-A® mesh [10]. Materials and methods: Clinical CaseFemale patient; 65-year old; 6-year classic history of GERD (regurgitation, belching, bloating, “acid in the throat” treated for several years by multiple proton pump inhibitors); BMI 22. An EGDS revealed a > 3 cm hiatal hernia, grade B Los Angeles esophagitis. 24-hour pH study was positive for acid reflux and esophageal manometry revealed LES intrathoracic dislocation. With laparoscopic 5-trocars approach, the hiatal hernia defect was identified and primarily repaired, by crural closure, with size 0 permanent suture (ETHIBOND). GORE BIO-A® Tissue Reinforcement was trimmed to fit the defect with a “U” shape cutout to accommodate the esophagus. It was secured using two absorbable sutures (VICYRL). At least A Nissen fundoplication was performed without incident. Result: Gore BIO-A® mesh was easily placed through a 10-12 mm trocar. It had good handling characteristics laparoscopically, and no pre-operative preparation was required of the prosthetic. It can be cut and tailored intraoperatively to an optimal adaptation. There were no short-term complications from the mesh. The patient had not significant post-operative sequelae. ConclusionCrural closure reinforcement during hiatal hernia repair can be done readily with this new totally absorbable Gore Bio A Tissue Reinforcement: it is a 3D web of completely absorbable synthetic polymers replaced by soft tissue over six months; it is a mix of glycolic acid and trimethylene carbonate and its function consistes in stimulating collagens deposition and ingrowth of new connective soft tissue [11]. It was demonstrated that G

UR - http://hdl.handle.net/10447/160321

UR - http://www.pagepressjournals.org/index.php/jbr/article/view/jbr.2015.5161/4551

M3 - Book/Film/Article review

VL - 88

SP - 19

EP - 20

JO - JOURNAL OF BIOLOGICAL RESEARCH

JF - JOURNAL OF BIOLOGICAL RESEARCH

SN - 1826-8838

ER -