210. BIORESORBABLE SYNTHETIC MESHES IN LARGE PARAESOPHAGEAL HERNIAS. TECHNIQUE OF APLICATION AND EARLY RESULTS

Abstract Background Large paraesophageal hernias (LPEH) are still a challenge faced by foregut surgeons. Surgical options are highly debated among specialists; esophageal lengthening procedures, diaphragmatic relaxing incisions, gastropexy and—mesh reinforcement. Severe complications related to synthetic meshes has led many surgeons to avoid this type of reinforcement. However, newly developed synthetic bioresorbable meshes have been used as an alternative for hiatal reinforcement, lowering the rates of recurrence without the drawbacks of synthetic materials. Methods From April 2018 to February 2023, 65 patients underwent LPEH repair with hiatal augmentation with an inverted C-shape bioresorbable mesh. All surgeries were performed by two surgeons (AB and NCA). The meshes (Bio-A®—Gore® and Phasix ST®—BARD) were applied over crurorrhaphy, covering the anterior and posterior aspects of the hiatus and secured in place with sutures and cyanoacrylate. The choice of mesh was determined by the surgeon’s preference. Follow up visits were at 1, 6 and 12 months and yearly after that. Results There were 34 patients where Bio-A was used and 31 with Phasix. Median age (55,5 vs 54,8 years) didn’t differ between groups. LPEH were primary (PS) in 39 patients and recurrence from prior interventions (RS) in 26. Median age was higher in PS (58,6 vs 49,6 years). There were no intraoperative complications related to the use of mesh. The patients were discharged after 24–48 hours. The average follow-up period was similar between PS and RS (10,1 vs 9,6 months). There were three recurrences (2 Bio-A, 1 Phasix) in PS (7,6%) and seven (26,9%) in RS (2 Bio-A, 5 Phasix). There weren’t complaints of prolonged dysphagia or need for dilatation. Nine out of 10 recurrences are small. One large recurrence, required reintervention for acute volvulus after 1 year (RS group with Phasix). Conclusion bioresorbable meshes are safe to use as a reinforcement of hiatoplasty in LPEH. They can reduce recurrence and reoperation rates in PS at a short term follow-up. Large recurrent hiatal hernias still present as a major challenge and adjuvant techniques should be employed to further reduce recurrences.