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Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair

INTRODUCTION: Complex and recurrent paraesophageal hernia repairs are a challenge for surgeons due to their high recurrence rates despite the use of various prosthetic and suturing techniques. METHODS: Here we describe the use of vascularized fascia harvested from the posterior rectus sheath with pe...

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Autores principales: Vigneswaran, Yalini, Bryan, Ava F., Ruhle, Brian, Gottlieb, Lawrence J., Alverdy, John
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer US 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760196/
https://www.ncbi.nlm.nih.gov/pubmed/34506032
http://dx.doi.org/10.1007/s11605-021-05134-7
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author Vigneswaran, Yalini
Bryan, Ava F.
Ruhle, Brian
Gottlieb, Lawrence J.
Alverdy, John
author_facet Vigneswaran, Yalini
Bryan, Ava F.
Ruhle, Brian
Gottlieb, Lawrence J.
Alverdy, John
author_sort Vigneswaran, Yalini
collection PubMed
description INTRODUCTION: Complex and recurrent paraesophageal hernia repairs are a challenge for surgeons due to their high recurrence rates despite the use of various prosthetic and suturing techniques. METHODS: Here we describe the use of vascularized fascia harvested from the posterior rectus sheath with peritoneum during robotic hiatal hernia repair in two patients with large complex diaphragmatic defects. RESULTS: Successful harvesting and onlay of the right posterior rectus sheath based on a falciform vascular pedicle was achieved robotically by rotating and securing the flap to the diaphragmatic hiatus as an onlay flap following cruroplasty of the hiatal defect. CONCLUSIONS: In patients with difficult to repair large paraesophageal hernias, we demonstrate a promising new technique to restore the dynamic hiatal complex with the tensile strength of autologous vascularized fascia and peritoneum. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11605-021-05134-7.
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spelling pubmed-87601962022-01-26 Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair Vigneswaran, Yalini Bryan, Ava F. Ruhle, Brian Gottlieb, Lawrence J. Alverdy, John J Gastrointest Surg Multimedia Article INTRODUCTION: Complex and recurrent paraesophageal hernia repairs are a challenge for surgeons due to their high recurrence rates despite the use of various prosthetic and suturing techniques. METHODS: Here we describe the use of vascularized fascia harvested from the posterior rectus sheath with peritoneum during robotic hiatal hernia repair in two patients with large complex diaphragmatic defects. RESULTS: Successful harvesting and onlay of the right posterior rectus sheath based on a falciform vascular pedicle was achieved robotically by rotating and securing the flap to the diaphragmatic hiatus as an onlay flap following cruroplasty of the hiatal defect. CONCLUSIONS: In patients with difficult to repair large paraesophageal hernias, we demonstrate a promising new technique to restore the dynamic hiatal complex with the tensile strength of autologous vascularized fascia and peritoneum. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11605-021-05134-7. Springer US 2021-09-10 2022 /pmc/articles/PMC8760196/ /pubmed/34506032 http://dx.doi.org/10.1007/s11605-021-05134-7 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Multimedia Article
Vigneswaran, Yalini
Bryan, Ava F.
Ruhle, Brian
Gottlieb, Lawrence J.
Alverdy, John
Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair
title Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair
title_full Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair
title_fullStr Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair
title_full_unstemmed Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair
title_short Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair
title_sort autologous posterior rectus sheath as a vascularized onlay flap: a novel approach to hiatal hernia repair
topic Multimedia Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760196/
https://www.ncbi.nlm.nih.gov/pubmed/34506032
http://dx.doi.org/10.1007/s11605-021-05134-7
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