Veritas Laparoscopic Paraesophageal Hiatal Hernia (PEH) Repair Pilot Trial

This is an investigator initiated pilot study to observe the short-term outcomes (a follow-up
period of up to six months) of patients who undergo a laparoscopic paraesophageal Hiatal
hernia (PEH) repair using the Veritas® Collagen Matrix brand biological mesh. This is a
preliminary study at the University of Washington.

A PEH occurs when the stomach protrudes through the diaphragm next to the esophagus. The
chance of recurrence of a Hiatal hernia after laparoscopic PEH repair is between 20-40%
within 6 months.During laparoscopic PEH repair, a mesh-type product is used as a scaffold.
The mesh serves as a reinforcing material during the surgical repair. It is cut to the
appropriate size needed for the hernia and sutured to the surrounding diaphragmatic tissue.
There are many different types of meshes available on the market, and vary in the degree of
manageability, strength, and adherence.

Although surgical meshes work on the same principal, the variance between materials may
affect patient outcomes. There is evidence that a biologic mesh, specifically one derived
from Small Intestinal Submucosa (SIS), decreases the short-term (6-month) recurrence rates
compared to a synthetic mesh or another type of biologic mesh. A biologic mesh, serving as a
scaffold, will be replaced by the patient's own tissue after about 6 months. Theoretically,
this would prevent the possible complications associated with synthetic mesh including mesh
erosion into the esophagus or stricture of the esophagus.

There are some case series showing similar short-term results between the different biologic
meshes, but there is no direct comparative data.