Biological Materials for Diaphragmatic Repair: Initial Experiences with the PeriGuard Repair Patch®

Abstract

Background: We sought to analyze the efficacy of a bovine pericardial patch (PeriGuard®) for diaphragmatic repair. Methods: Seven consecutive patients (6 males, median age 56 years) scheduled for diaphragmatic resection and/or repair were enrolled in this study. In all cases diaphragmatic repair was performed with a PeriGuard Repair Patch® (Synovis, St. Paul, MN, USA). At follow-up (median: 12 months; range: 6–18 months), quality of life, signs of reherniation and incorporation of mesh were assessed through clinical examination, blood samples and CT or MRT scan. Results: Diagnosis on admission included sarcoma (n = 2), mesothelioma (n = 1), squamous cell carcinoma (n = 1), parachordoma (n = 1) and large congenital or posttraumatic herniation (n = 2). At follow-up successful diaphragmatic repair with no signs of reherniation, graft dehiscence or seroma formation was confirmed for all patients. Recorded inflammatory markers [C-reactive protein (CRP), white blood cell count (WBC) and procalcitonin (PCT)] reached their peak values between postoperative day (POD) 4 and POD 7. Values ranged from 122–282 mg/L for CRP, 0.4–4.6 µg/L for PCT and 6.2–15.6 Tsd/µL for WBC. Overall oncological results were good and 5 out of 6 survivors reported a fully reestablished quality of life. Conclusion: We consider the PeriGuard Repair Patch® a viable alternative to synthetic materials for diaphragm replacement. Moreover, we advise carrying out cautious follow-up in patients undergoing extensive oncological resection to learn more about the biological behavior of the bovine PeriGuard Repair Patch® after diaphragmatic repair.

Key words

diaphragm - xenograft - lung cancer treatment (surgery - medical) - biomaterials - diaphragmatic resection - diaphragmatic repair

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