Dr. Constantine Frantzides, professor of surgery and director of minimally invasive surgery program at Rush and surgeons at the University of Nebraska Medical Center in Omaha, Neb., conducted a randomized study comparing traditional hernia surgery with surgery done with a mesh patch for patients with large (eight centimeters) hernias in their diaphragms. In traditional hiatal hernia surgery, the left and right bundles of tissues comprising the diaphragm are sewn together to close the hernia or reduce the size of the defect. In the newer method using a polytetrafluoroetheleyene (PTFE) mesh patch, surgeons suture the patch to the sides of the defect. Frantzides discovered that patients receiving this method of surgery had no recurrence of their hernias. The results were published in the June issue of the journal Archives of Surgery.
Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm, which is the muscle separating the stomach from the chest. Hiatal hernias are more common in those over age 50 and can be caused by obesity, pregnancy, tight clothing, sudden physical exertion, such as weight lifting, straining, coughing, or abdominal injury. After repair, the diaphragm is susceptible to re-injury from coughing, sneezing, straining and laughing.
In his study, Frantzides randomly assigned 72 patients to either traditional hiatal hernia surgery or to surgery using a mesh patch. Among the 36 patients who received the traditional surgical method, eight, or 22 percent, had recurrences of their hernia, compared to none in the group treated with the mesh patch.
"Although more expensive and slightly longer, the technique with an onlay mesh patch for large hiatal hernia results in a lower rate of recurrence," Frantzides said. The study is the first to compare two different methods of hiatal hernia surgery, Frantzides said.