Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0-24%). However, mesh complications have been reported.
We compiled three cases and our senior author contacted other experienced esophageal surgeons who provided 26 additional cases with mesh related complications. The data collected was merged into an excel 2003 spread sheet for analysis.
All patients underwent laparoscopic surgery for a large hiatal hernia. Twenty six had a concomitant Nissen fundoplication and three a Toupet fundoplication Mesh types placed were polypropylene n=12, PTFE n=10, small intestine submucosa n=3 and dual mesh n=4. Primary symptoms associated with the complications were dysphagia n=23, vomiting n=1, regurgitation n=2, obstipation and abdominal distention n=1, chest pain n=1 and weight loss n=1. Pre-operative findings were intra-luminal mesh erosion n=7, hiatal stenosis n=18 and extensive adhesions n=4. Six patients required an esophagectomy, two patients a partial gastrectomy, 4 patients did not need surgery with one patient having a stent placement in this group and the remainder had mesh removal by laparoscopy or open surgery. There was no immediate operative mortality, however, 5 patients have severe gastroparesis and two patients are dependent on tube feedings. The remainder of patients had a satisfactory outcome.
Further prospective studies are needed to determine the place for mesh reinforcement of the crural closure.
Session: Podium Presentation
Program Number: S105