N 6 (178) 2021. P. 32–37

MEASUREMENT OF FORCE OF TENSION DURING LAPAROSCOPIC CRURORAPHY TO DEFINE INDICATION TO MESH IMPLANTS

V. V. Grubnik, V. V. Grubnik, R. S. Parfentiev

Odesa National Medical University MH of Ukraine, Odesa, Ukraine

DOI 10.54229/2226-2008-2021-6-6

The aim of the study was to study the indications for the use of mesh implants in patients with large hiatal hernias, depending on the tension of the crura.

Materials and methods. Using a Walcom Fm-204-50k digital force gauge, we measured the force of crural tension during laparoscopic cruroraphy in 115 patients who met the inclusion criteria for participation in the study. All patients underwent intraoperative measurement of the tension force of the crura during the crura repair. All patients, whose tensile strength during measurement was > 4 N (n=69), were randomly divided into two groups. The first group included 30 patients who underwent hiatal hernia repair using a collagen-coated Parietex mesh implant. The second group included 39 patients who underwent simple suturing of the crura (cruroraphy).

Results. The main and control groups did not differ significantly in terms of age, gender, quality indicator and the area of hiatal surface (p>0.05). According to the results of measuring the tension of the sutures during cruroraphy, the average tensile force of the suture closest to the esophagus was 5.2 (from 4.0 to 8.2 N). When performing anterior cruroraphy, the tensile force of the seams averaged 3.5 N (from 2.4 to 4.7 N). Over an average follow-up period of 48 months, anatomical relapses were revealed in 1 patient of group I and in 6 patients of group II (p=0.004). Patient satisfaction was significantly higher in the mesh implant group (p=0.004). The mesh group showed a greater improvement in GERD-HRQL (p<0.0001) compared to the non-mesh group.

Conclusion. Laparoscopic repair of large hiatal hernias using a collagen-coated Parietex mesh implant in patients with a cruraraphy suture pull force > 4 N is safe and can prevent anatomical recurrence.

Key words: hernia of the esophageal orifice of the diaphragm, laparoscopic cruroraphy, measuring the tension of the seams of the cruroraphy.

REFERENCES

  1. Frazzoni M, Piccoli M, Conigliaro R, Frazzoni L, Melotti G. Laparoscopic fundoplication for gastroesophageal reflux disease. World J Gastroenterol. Oct 21,2014;20(39):14272-14279. DOI: 10.3748/wjg.v20.i39.14272
  2. Engström C, Cai W, Irvine T, Devitt PG, Thompson SK, Game PA, Bessel JR, Jamieson GG, Watson DI. Twenty years of experience with laparoscopic antireflux surgery. Br J Surg 2012;99:1415-1421. DOI: 10.1002/bjs.8870.
  3. Oor JE, Roks DJ, Koetje JH. et al. Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh. Surg Endosc. 2018;32:4579. https://doi.org/10.1007/s00464-018-6211-3
  4. Grubnik VV, Malynovskyy AV. Laparoscopic repair of hiatal hernias: new classification supported by long-term results. Surg Endosc. 2013;27: 4337-4346. DOI: 10.1007/s00464-013-3069-2.
  5. Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointer R. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg. 2005;140:40-48. DOI: 10.1001/archsurg.140.1.40
  6. Frantzides CT, Carlson MA, Loizides S, Papafili A, Luu M, Roberts J, Zeni T, Frantzides A. Hiatal hernia repair with mesh: a survey of SAGES members. Surg Endosc. 2010;24:1017-1024. https: //doi.org/10.1007/s00464-009-0718-6
  7. Tatum RP, Shalhub S, Oelschlager BK, Pellegrini CA. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg. 2008;12:953-957. DOI: 10.1007/s11605-007-0316-7
  8. Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointer R. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg. 2005;140:40-48. DOI: 10.1001/archsurg.140.1.40
  9. Oor JE, Roks DJ, Koetje JH et al. Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh. Surg Endosc. 2018;32:4579. https://doi.org/10. 1007/s00464-018-6211-3
  10. Watson DI, Thompson SK, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG. Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial. Ann Surg. 2015;261:282-289. DOI: 10.1097/SLA.0000000000000842.
  11. Navaratne L, Ashrafian H & Martнnez-Isla A. Quantifying tension in tension-free hiatal hernia repair: a new intra-operative technique. Surg Endosc 2019;33:3040-3049. https://doi.org/10.1007/s00464-019-06843-6
  12. Grubnik VV, Tkachenko AI, & Grubnik VV. Dependence of the recurrence development on the sutures tension force while performance of laparoscopic cruroraphy. Klinicheskaia Khirurgiia. 2020;87(1/2):30-34. https://doi.org/10.26779/2522-1396.2020.1-2.30
  13. Granderath FA, Schweiger UM, Pointner R. Laparoscopic antireflux surgery: tailoring the hiatal closure to the size of hiatal surface area. Surg Endosc. 2007;21:542-548. https://doi.org/10.1007/s00464-006-9041-7
  14. Tam V, Winger DG, Nason KS. A systematic review and meta-analysis of mesh versus suture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg. 2016;211:226-238. DOI: 10.1016/j. amjsurg. 2015.07.007.
  15. Watson DI, Thompson SK, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG. Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial. Ann Surg. 2016;261:282-289. DOI: 10.1097/SLA. 0000000000000842.
  16. Huddy JR, Markar SR, Ni MZ, Morino M, Targarona EM, Zaninotto G, Hanna GB. Laparoscopic repair of hiatus hernia: Does mesh type influence outcome? A meta-analysis and European survey study. Surg Endosc. 2016;30:5209-5221. https://doi.org/10.1007/s00464-016-4900-3
  17. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009;23(6):1219-1226. DOI: 10.1007/s00464-008-0205-5.
  18. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair a multicentre, prospective, randomized trial. Ann Surg. 2006;244:481-488. DOI: 10.1097/01.sla.0000237759.42831.03
  19. Bradley DD, Louie BE, Farivar AS, Wilshire CL, Baik PU, Aye RW. Assessment and reduction of diaphragmatic tension during hiatal hernia repair. Surg Endosc. 2015;29(4):796-804. DOI: 10.1007/s00464-014-3744-y.
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