Esophageal hiatus repair: comparison study of three reinforcement meshes in a preclinical porcine model

AMIGO, NATALIA; RAMÍREZ, MAURICIO; PASCANER, ARIEL; ZUBIETA, CECILIA; NIEPONICE, ALEJANDRO; RENDA, PABLO; VIGLIANO, CARLOS; RIGANTI, JUAN MARTIN; LOVERA, ROMINA; CRAIEM, DAMIÁN

Mar del Plata

Congreso; Reunión Anual Sociedad Argentina de Investigación Clínica; 2018

Sociedad Argentina de Investigación Clínica

ESOPHAGEAL HIATUS REPAIR: COMPARISON STUDY OF THREE REINFORCEMENT MESHES IN A PRECLINICAL PORCINE MODELNatalia Amigo, PhDb, Cecilia Zubieta, MDa, Juan Martin Riganti, MDa, Mauricio Ramirez, MDa, Pedro Renda, MDa, Romina Lovera, MDa, Ariel Pascaner, Engb, Carlos Vigliano, MD, PhDa, b, Damián Craiem, PhDb and Alejandro Nieponice, MD, PhDa, ba Esophageal Institute, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina.b Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMETTYB), Universidad Favaloro-CONICET, Bs As, ArgentinaLaparoscopic repair of the hiatal hernia is associated with a recurrence rate between 12% and 42% depending on the defect size. The main limitation of hiatal reinforcement has been the risk of adverse events related with the use of synthetic meshes in the vicinity of the esophagus.Aims: To evaluate the biomechanical characteristics and histologic remodeling of a non-absorbable synthetic mesh, an absorbable biosynthetic mesh and an absorbable biologic mesh in a preclinical model of laparoscopic hernia repair.15 Landrace pigs underwent laparoscopic primary hiatal hernia repair of a simulated defect in the esophageal hiatus. Five pigs were reinforced with a non-absorbable synthetic polypropylene mesh (Prolene®: PP), five with an absorbable biosynthetic scaffold (Gore Bio-A®: PGA) and five with an absorbable biologic extracellular matrix scaffolds, (Matristem®: ECM). Animals were euthanized at 12 weeks. Endpoints included gross morphology with adhesion assessment, mechanical testing and histology.The site of the repaired defect reinforced with ECM scaffolds showed a robust closure of the crura with a smooth peritoneal structure that covers the entire repair, while those repaired with PP or PGA showed thickening and fibrosis at the repair site. Load at failure and stiffness of the PP group were significantly higher than of ECM group (2171.8±607.8 vs. 1196.8±518.1 P