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Onlay Hiatal Reinforcement Utilizing Human Acellular Dermal Matrix: Three Case Series

US Army, Department of General Surgery, William Beaumont Army Medical Center, 5005 North Piedras Street, El Paso, Texas 79920-5001 jason.johnson35{at}us.army.mil

Brennan J. Carmody, MD

Department of General Surgery, Walter Reed Army Medical Center, Washington, DC

Mohammad K. Jamal, MD

Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA

Eric J. Demaria, MD

Department of General Surgery, Duke University Medical Center, Durham, NC

Redo laparoscopic fundoplication and laparoscopic repair of large (> 5cm) paraesophageal hernias have a high rate of recurrence after primary suture repair of the hiatal defect. As such, the use of mesh prosthesis as an interposition graft or onlay reinforcement is becoming more popular for the repair of larger, more complicated crural defects. We report three cases in which human acellular dermal matrix was used as an onlay reinforcement of the hiatus after primary suture closure. Two patients had large paraesophageal hernias (one type III and one type IV). The third patient became symptomatic after her second laparoscopic antireflux procedure and was found to have recurrent herniation of the fundus into the mediastinum. All three patients underwent successful laparoscopic repair. There were no intraoperative or postoperative complications. All three patients remain symptom free with follow-up ranging from 8 months to 10 months. Acellular dermal matrix appears to be a promising prosthetic for onlay reinforcement of the hiatus during redo laparoscopic fundoplication and repair of large paraesophageal hernias.

Key Words: laparoscopic fundoplication • paraesophageal hernias • mesh prosthesis

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