Biomechanical features of reinforced esophageal hiatus repair in a porcine model

AMIGO NATALIA; CECILIA ZUBIETA; JUAN MARTIN RIGANTI; MAURICIO RAMIREZ; PEDRO RENDA; ROMINA LOVERA; ARIEL PASCANER; CARLOS VIGLIANO; DAMIAN CRAIEM; ADAM YOUNG; THOMAS GILBERT; ALEJANDRO NIEPONICE

JOURNAL OF SURGICAL RESEARCH

ACADEMIC PRESS INC ELSEVIER SCIENCE

Lugar: Amsterdam; Año: 2019

0022-4804

Recurrence rates in the laparoscopic repair of the hiatal hernia range from 12% to 59%.Limitation of reinforcement has been principally the risk of adverse events caused by syntheticmaterials. Biologic and resorbable synthetic materials are valid alternatives. This studycompares the host response to all these materials after hiatal hernia repair. A total of 20Landrace pigs, underwent laparoscopic primary hiatal hernia repair and reinforced with apolypropylene mesh (PROLENE: polypropylene [PP]), an absorbable synthetic scaffold (GOREBIO-A: polyglycolic acid [PGA]), a urinary bladder matrix scaffold, (Gentrix: urinary bladdermatrix [UBM]), or without reinforcement, control group (C). Animals were survived for3 months. Endpoints included gross morphology, biomechanical testing, and histology. Pigsin PP and PGA groups showed fibrosis at the repair site, with robust adhesions. In UBM and Cgroups, onlymild adhesions were found. Load at failure (gr) and stiffness (gr/mm) of PP werehigher than C group (PP:2103 548.3 versus C:951.1 372.7, P ¼ 0.02; PP:643.3 301 versusC:152.6 142.7, P ¼ 0.01). PGA and UBM values for both parameters were in between PP and Csamples. However, stiffness in UBM was tended to be lower than PP group, and approached asignificant difference (643.3 301 versus 243 122.1, P ¼ 0.0536). In UBM group, the histologyresembled native tissue. By contrast, PP and PGA groups showed mononuclear infiltrates,fibroencapsulation, necrosis, remnants of mesh, and disorganized tissue that was validatedwith a histologic score. In this setting, UBM scaffolds showed the most appropriate featuresfor hiatal hernia repair, recovering the tissue properties that can help reduce the possibilityof early failure and prevent complications associated with the implanted material.