Jason M Pfluke, MD, C. Daniel Smith, MD. Mayo Clinic in Florida
INTRODUCTION – Mesh use as an adjunct to hiatal hernia repair has been suggested to be safe and effective. Concern has been raised about the risk of mesh related complications like erosion, and the higher risk of complications if redo hiatal surgery is undertaken after mesh has been used. Available data has not established a clear role for mesh in hiatal hernia repair. To assess surgeon’s adoption of the use of mesh for hiatal hernia repair, SAGES members were surveyed regarding their practice related to mesh use for hiatal hernia repair.
METHODS AND PROCEDURES – Between April and September 2010, a well-known internet-based survey tool was used to survey 5,309 active SAGES members. Potential participants were contacted via email and invited to complete the survey. The mailing list was obtained using a publicly available SAGES membership directory. Responses were collected between April and September 2010. Of the 5,309 attempted contacts, 4,927 reached active email accounts of SAGES members. From these, 2,262 members responded (46% response rate).
RESULTS – The majority of respondents perform hiatal hernia repair (68.1%), but only 19% perform more than 20 per year. The vast majority (97%) use a laparoscopic approach for the majority of repairs. While 25% of surgeons use mesh for the majority of repairs, 22% of surgeons never use mesh. An absorbable mesh is most commonly used (68%). An on-lay technique is used in 93%, with a variety of mesh shapes and fixation. Only 7% of surgeons who have been in practice more than 20 years use mesh compared to 59% of surgeons in practice less than 10 years. Nearly 59% of surgeons have never performed revisional foregut surgery on a patient with prior mesh.
CONCLUSION(S) – While the majority of surgeons have used mesh for hiatal hernia repair, it is the minority who use it routinely, with younger surgeons more likely to use mesh than older surgeons. Absorbable mesh is most commonly used. When mesh is used, an on-lay technique is most commonly used. There is no clear accepted use of mesh in hiatal hernia repair.
Program Number: S011