Biological materials for diaphragmatic repair: initial experiences with the PeriGuard Repair Patch®

Our plain-English summary of Biological materials for diaphragmatic repair: initial experiences with the PeriGuard Repair Patch®, by P. Zardo, R. Zhang, B. Wiegmann, et al (The Thoracic and Cardiovascular Surgeon, 2011).

The study

• Authors: P. Zardo, R. Zhang, B. Wiegmann, A. Haverich, S. Fischer
• Journal: The Thoracic and Cardiovascular Surgeon
• Published: 2011;59(1):40-4
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

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.

© Georg Thieme Verlag KG Stuttgart · New York.

In plain English

This article was a small case series on a patch made from cow (bovine) pericardium, the PeriGuard Repair Patch, used to repair the diaphragm after surgery. It did not discuss asbestos. Seven consecutive patients (six men, one woman, median age 56) were included. Data were recorded at the time and analyzed afterwards. One patient had mesothelioma and underwent extrapleural pneumonectomy. The others had sarcoma, parachordoma, squamous cell lung cancer, or large hernias. At follow-up, scans in all examined patients showed the patch well incorporated, with no graft failure, reherniation or calcification. Five of six surviving patients reported good to excellent quality of life. The mesothelioma patient died after 8 months, and there was no autopsy. In one synovial sarcoma patient, a later operation found bacterial and, in the authors' words, fungal infection of the patch. The authors concluded that the patch was a viable alternative to synthetic materials. They advised cautious follow-up after extensive cancer surgery and said further studies were needed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series of consecutive surgical patients; data recorded prospectively and analyzed retrospectively
• Who was studied: Seven consecutive patients (6 male, 1 female; median age 56, range 20 to 75) scheduled for full thickness diaphragmatic resection and replacement at the authors' institution, March 2008 to January 2009
• Exposure: No asbestos exposure was studied or reported. The treatment studied was diaphragm replacement with a single layer bovine pericardial PeriGuard Repair Patch
• Main results:
  • Diagnoses on admission: sarcoma (n = 2), mesothelioma (n = 1), squamous cell carcinoma (n = 1), parachordoma (n = 1), and large congenital or posttraumatic herniation (n = 2). The mesothelioma patient had an extrapleural pneumonectomy with pericardial and diaphragmatic resection
  • In all examined patients, scans showed good incorporation of the patch into surrounding tissue, with no signs of graft failure, reherniation or calcification
  • On the SF-36 health survey, quality of life was good to excellent in 5 of 6 surviving patients. One patient reported a new onset pain syndrome
  • The patient with malignant mesothelioma died after 8 months (in the discussion, from a relevant cardiac comorbidity) and had a prolonged hospital stay
  • Inflammatory markers in the seven patients peaked between postoperative days 4 and 7. CRP ranged from 122 to 282 mg/L, PCT from 0.4 to 4.6 µg/L, and WBC from 6.2 to 15.6 Tsd/µL
  • Apart from one patient with a secondary pleural effusion, no further postoperative adverse events were observed. Median hospital stay was 8 days (range 4 to 78)
  • One patient with synovial sarcoma developed a late bronchopleural fistula 16 months after chest wall and diaphragm resection
  • In that patient, microbiological analysis found infection of the PeriGuard graft, described by the authors as fungal (Actinomyces odontolyticus) and bacterial (Streptococcus sp.)
• The authors' conclusion: The authors considered the PeriGuard Repair Patch a viable alternative to synthetic materials for diaphragm replacement. They advised cautious follow-up in patients undergoing extensive oncological resection
• Limitations the authors state:
  • No valid methods were available to disprove the follow-up findings of adequate tissue incorporation
  • In patients with extensive cancer, blood markers of infection (WBC, CRP, PCT) can give false-negative results and may mask severe graft contamination
  • No autopsy was done on the mesothelioma patient, so how well the patch was incorporated could not be checked by tissue examination
  • No conclusive data were available on whether bovine pericardial grafts are particularly prone to local infection
  • Further studies were needed to validate the results

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Diaphragmatic Resection, Quality of Life, Sarcoma, Mesothelioma, Squamous Cell Carcinoma, Diaphragm.

Related studies

• Initial experience with the use of biological implants for soft tissue and chest wall reconstruction in thoracic surgery — A. Barua, J.A. Catton, et al. (2012)
• A new technique of diaphragmatic patch fixation in extrapleural pneumonectomy — M. Schiavon, A. De Filippis, et al. (2010)
• Laparoscopic repair of gastric herniation after extrapleural pneumonectomy for mesothelioma — M. Egan, B.E. Louie, et al. (2012)
• Polytetrafluoroethylene or Acellular Dermal Matrix for Diaphragmatic Reconstruction? — J.K. Bassuner, D.C. Rice, et al. (2017)
• Left diaphragmatic hernia complicated by perforation of an intrathoracic gastric ulcer into the aorta: report of a case — Y. Saito, Y. Yamakawa, et al. (2000)
• Long term survival and perioperative propensity score matched outcomes of diaphragmatic resections compared to stripping in cytoreductive surgery + intra-peritoneal chemotherapy — B. Singh, G. Singh, et al. (2020)

Browse more research in The Thoracic and Cardiovascular Surgeon, or return to medical research.