H Poon, MD MRCS, A Patel, MD MRCS, A S Perry, MD FRCS, M S Wadley, MD FRCS. Department of Upper GI Surgery, Worcestershire Royal Hospital, Worcester, UK
Paraesophageal hiatus hernias (PHH) can present with disabling symptoms and may result in life-threatening complications. Laparoscopic repair is now considered routine in many centres although a number of studies have reported high recurrence rates. Tension free repair with prosthetic mesh reinforcement of the crura has been advocated and reported to result in significantly lower rates of recurrence. This technique however has the potential to result in significant complications including mesh erosion. Our study aimed to assess the outcome and complications of the use of prosthetic mesh in the repair of giant PHH.
All patients undergoing laparoscopic repair of giant PHH by two surgeons in a UK district general hospital from 2005 to 2011 were studied. Only patients who underwent repair using PTFE mesh (Bard Crurasoft® patch) were included. Surgery involved reduction of hernia contents and complete reduction of the sac. The crural defect was repaired using interrupted sutures buttressed with a PTFE mesh. Basic demographics, length of stay, complications, recurrence and follow up details were noted.
36 patients were included [M:F 17:19, median age 64yrs (range 53-79yrs)]. There were 5 (15%) emergency cases. Median post-operative length of stay was 3 days (range 1-5 days). There were no significant intra-operative complications or conversions to open surgery. One patient developed early in-hospital recurrence requiring redo laparoscopic surgery. After median follow-up 40 months (range 9-68 months), 8 patients (22%) developed symptoms requiring further investigation (5 diarrhoea, 3 reflux symptoms, 1 port site hernia). In these patients endoscopy and upper GI series revealed no evidence of hiatal hernia recurrence, mesh erosion or migration.
Use of prosthetic mesh in the repair of large PHH appears safe with an acceptable complication rate and low incidence of recurrence with medium-term follow up. Longer follow up of our patients is needed and further studies should be commissioned to assess the long-term impact of prosthetic materials in the repair of these challenging hernias.
Session Number: Poster – Poster Presentations
Program Number: P228