A Complication of Biologic Mesh Following Nissen Fundoplication

Edward L Felix, MD, Daniel E Swartz, MD. Advanced Bariatric Centers of California

The role of synthetic or biologic mesh to reinforce or close the hiatus during Nissen fundoplication has become controversial. A randomized study has shown it to be beneficial for para-esophageal hernia repair, but at what risk. Some have suggested that the potential risk of a serious complication from mesh (synthetic and biologic) around the hiatus is greater than the risk of failure of a repair without mesh.

Our video demonstrates a complication, not previously reported, that was the direct result of a biologic mesh used to reinforce a hiatal closure during a routine Nissen fundoplication. The patient developed severe intractable dysphagia following the initial repair that utilized a biologic mesh anchored to the crus with spiral tacks. After multiple attempts at conservative management, the patient was laparoscoped. The etiology of the obstruction was revealed at surgery and treated with a successful outcome.

The patient developed a sterile abscess surrounding the esophagus as a result of the patient’s reaction to a biologic mesh. The video demonstrates the technique used to safely dissect out the abscess and scar tissue in order to relieve the patient’s dysphagia. The potential severity of this complication is well demonstrated by the video. Questions are posed however about the true incidence and severity of complications resulting from the use of even biologic meshes. Further studies are suggested to evaluate the role of mesh around the hiatus.