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MESH OR NO MESH FOR LAPAROSCOPIC HIATAL HERNIOPLASTY: PREVENTION OF RECURRENCE VS AVOIDING ESOPHAGIC EROSION, FACING A LARGE SURGICAL DILEM

Daniel Gomez, MD, FACS1, Luis F Cabrera, General Surgeon2, Andrez Mendoza, General Surgeon2, Mauricio Pedraza2, Jean Pulido2, Eric E Vinck2, Sebastian Sanchez2. 1CPO, 2Bosque University

Introduction: The use of mesh in the laparoscopic repair of paraesophageal hernias has been shown to reduce recurrence, only a few studies have shown a prevention of it as reported by Frantzides et al. The incidence of complications such as erosion of the esophagus is 10.1% as reported by Sathasivam and collaborators, using polypropylene and polytetrafluoroethylene meshes, however in the market the polyester mesh covered with collagen is offered as an option to avoid this type of complications.

Objective: To show our experience in the laparoscopic repair of giant hiatal hernia using this type of specific mesh in order to establish if there are complications associated with it.

Materials and Methods: Retrospective, descriptive observational study, including symptomatic patients with giant hiatal hernia grade III and IV, taken to laparoscopic hiatal hernioplasty with polyester mesh covered with collagen (Parietex Composite HiatalR), in our institution, from November 2013 to February 2017. Evaluating the following variables: age, sex, type of hernia for esophageal, surgical time, bleeding, recurrence, esophageal mesh incorporation, complications, conversion and mortality.

Results: 24 patients were taken to laparoscopic hiatal hernioplasty with polyester mesh covered with collagen (Parietex Composite Hiatal®, Medtronic Inc., Minneapolis, USA) with 0% conversion rate. The average size of hiatal hernias was 4.3 cm and the most common type of hernia was III in 86%. With an average surgical time of 92.6 minutes and an average hospital stay of 26.3 hours. However, at 36 months, esophageal erosion occurred due to the incorporation of collagen-coated polyester mesh (Parietex Composite Hiatal®), with an incidence of this complication of 4.1% and a recurrence incidence rate of 4.1% at 24 months. Dysphagia incidence of 8.3%.

Conclusions: The use of the mesh in the laparoscopic repair of para esophageal hernias should be routine, in order to minimize hernia recurrence, however, as it can be seen in our study, the ideal mesh has not been designed yet for the esophageal hiatus, since, despite using a mesh technology covered with the latest technology such as collagen-coated polyester mesh (Parietex Composite Hiatal®, Medtronic Inc, Minneapolis, USA), a case of esophageal erosion was presented.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 96014

Program Number: P600

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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