Laparoscopic physiological hiatoplasty for XXXX : new composite "A"-shaped mesh. Physical and geometrical analysis and preliminary clinical results.

@entity1 @entity2910 @entity7502 @entity357 @entity1282 @entity736
BACKGROUND: We analyzed, using a theoretical model, the modality of recurrence after a simple cruroplasty for large @entity357 , and on the basis of physical and geometrical principles, we conceived a new shaped mesh for a "tension-free" repair. METHODS: We performed a physical and geometrical analysis of the hiatal region on a theoretical model. We also performed an anatomic study on 20 fresh cadavers to verify the reproducibility of the theoretical model and to study the most suitable shape for mesh and its adaptability to the hiatal region. Between September 2000 and October 2001, eight @entity1 received laparoscopic reparation of large (type II or III) @entity357 by means of a composite "A"-shaped @entity736 ( @entity736 )- @entity7502 mesh. There were two @entity1 and six @entity1 ; mean age was 65 years (range, 35-78 years). Concomitant @entity2910 was found in five @entity1 and impaired esophageal peristalsis in two @entity1 . A total or a partial fundoplication was associated in these cases. RESULTS: The physical and geometrical analysis of the hiatal region explained the reasons for the recurrence after hiatoplasty. The anatomical study on fresh cadavers resulted in a mesh tailored in an "A" shape and permitted to verify the adaptability of such a shaped mesh composed of two layers, @entity7502 and @entity736 . In the clinical series no conversions occurred; the mortality rate was null. Persistent @entity1282 was present in two @entity1 and disappeared after 3 months of treatment. No recurrence was observed at an 8-month average follow-up. CONCLUSION: The preliminary clinical study confirms the feasibility of this tension-free repair and the effectiveness of this composite A-shaped mesh.
