Reconstruction instead of strangulation
The key to the success of the operation lies in the realization that the closure between the stomach and esophagus is not achieved by a muscle in the esophagus but by a complex gear system of the organs involved. Research shows that the esophagus is not actually diseased in reflux patients, but rather that the position of the interlocking organs has simply shifted. You can imagine it like a complex clockwork: if one gear is displaced, the whole clock stops working. But the clock is basically intact and so is the gear! It just needs to be put back into its correct position in the system and secured there.
For humans, this means that the esophagus must be reinserted into the system so that all the gears can mesh together. The broken diaphragm must then be stabilized to provide its supporting function.
Does it really make sense to continue to follow the so-called "Gold standard" from the last century and tie the healthy stomach around the healthy esophagus because the diaphragm is broken?
The research results clearly show: No!
But how can you ensure that the functions regained in this way are retained permanently? This is where the second key lies: the development of the DeltaMesh. For the l.oe.h.d.e.-procedure, I have developed a new, patented mesh structure that is approved in Germany and the EU. This DeltaMesh differs fundamentally in form and structure from all meshes conventionally used in surgery. This is because its concept is precisely tailored to the requirements in the hiatus, both in terms of the special tissue situation and the pressure and tensile loads prevailing there.
Dr. Löhde is the inventor and patent holder. The patent is renewed annually.
In contrast, all conventional meshes, which are also used for diaphragmatic hernias, only follow a single-angle concept, i.e. the flat covering of defects originally developed for inguinal hernia surgery. But here in the diaphragm, it is not about simply covering a hole, but about reconstructing a complex closure function! Only then is the system as a whole intact again and all associated symptoms such as reflux, coughing, chest pain, heart problems, lump in the throat, hoarseness and many more disappear. Simply tying healthy tissue and closing it off or stapling some kind of mesh onto the diaphragm does not do justice to the special and sensitive situation in the hiatus.
However, the decisive factors for success are: a highly specialised team of surgeons experienced in minimally invasive surgery, knowledge of the researched closure function in humans with the 3-dimensional arrangement of the organs involved in the closure system, the ability to recognise the area of the correct organ bedding in each patient, and finally the skill to carry out the precise implantation of the DeltaMesh into the weakened diaphragm muscles in a minimally invasive manner.
Such training with final certification is time-consuming and requires the performance of many operations under supervision. This does not even include training in recurrence operations and dealing with complications.
These aspects have to be seen when the question is coming up as to why the l.oe.h.d.e.-procedure is not yet carried out everywhere.