• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Use of mesh repair in hiatal hernias

First submitted by:
Archana Ramaswamy
Print Friendly, PDF & Email

Introduction

Mesh has been increasingly used in hiatal hernia repair. This is still a controversial topic and the use of mesh in hiatal hernia surgery needs to answer the following questions:
What is the hiatal hernia recurrence rate with and without mesh hiatoplasty?
Does mesh affect GERD related outcome?
Are patients with recurrent hernia symptomatic and how many require reoperation?
What is the morbidity of reoperation?

Hiatal Hernia Recurrence with usage of mesh

Various studies have demonstrated lower recurrence with the use of mesh at the hiatus. A randomized study using suture crural closure vs reinforcement with a piece of 1×3 cm of polypropylene mesh demonstrated a recurrence rate of 26% vs 8% (p=0.001) at 1 year.1 The use of mesh in addition to sutures does not significantly change the recurrence rate compared with the use of mesh alone, though both have significantly reduced rates compared with suture alone.2 In a study using PTFE vs suture repair, on median follow-up of 56 months, recurrences in the mesh group were noted early in the postoperative period, whereas recurrence in the suture group continued without plateauing during the follow-up period.3 In addition to synthetic mesh, biologic mesh has also been shown to decrease recurrence rates in a randomized study comparing SIS vs suture repair with a 24% vs 9% recurrence rate.4

Does mesh affect GERD related outcome?

Rates of dyphagia appear to be increased early in the postoperative period, but are comparable to the non mesh group when followed out to 1 year.1 Even with biologic mesh usage, higher rates of post operative dysphagia are noted at 6 months compared with simple suture closure.4

Are patients with recurrent hernia symptomatic and how many require reoperation?

Recurrence rates following hiatal hernia surgery are difficult to estimate, with the highest rates (7-43%) being noted where radiologic follow-up is used. Symptoms in these patients range from 34-100%. SF-36 demonstrate lower quality of life scores in asymptomatic radiologic recurrences. 4 Reoperation rates though are low (1.7-4.2%) and are significantly higher (9.1% vs 2.3%) when mesh was used in the previous hernia repair.

What is the morbidity of reoperation?

A case series of complications in 28 patients following mesh reinforcement described mesh erosion, dense fibrosis, and esophageal stenosis in patients with previous PTFE, polypropylene and even biologic mesh. 32% of these patients required esophageal resection.5 On reoperation, patients with previous hiatal mesh had higher operative time, more blood loss, and increased need for esophageal resection compared with patients without previous hiatal mesh.6

 

 

References

1. Laparoscopic Nissen Fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation. Preliminary Results of a Prospective Randomized Functional and Clinical study. Granderoth FA, Schweiger UM, Kamolz T, Asche KU, Pointner R. Arch Surg 2005
2. Long-term results of hiatal hernia mesh repair and antireflux laparoscopic surgery. Soricelli E, Basso N, Genco A, Cipriano M. Surg Endosc 2009
3. Objective Follow-up after Laparoscopic Repair of Large Type III Hiatal Hernia. Assessment of Safety and Durability. Zaninotto G, Portale G, Costantini M, Fiamingo P, Rampado S, Giuroli E, Nicoletti L, Ancona E. World J Surg, 2007.
4. Biologic Prosthesis Reduces Recurrence after Laparoscopic Paraesophageal Hernia Repair, A multicenter, prospective, randomized trial. Oelschlager B, Pellegrini C, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Pollisar N, Mitsumori L, Nelson J, Swanstrom L. Ann Surg, 2006.
5. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Stadlhuber R, Sherif A, Mittal S, Fitzgibbbons R, Brunt M, Hunter J, DeMeester T, Swanstrom L, Smith CD, Fillipi C. Surg Endosc, 2009.
6. Hiatal mesh is associate with major resection at revisional operation. Parker M, Bray J, Harris A, Belli E, Pfluke J, Preissler S, Asburn H, Smith CD, Bowers SP. Presented at SAGES 2010.
7. Biological Mesh for Paraesophageal Hernia Repair – Pros & Cons. Steven .P. Bowers, M.D. Challenging Hernias Post-Graduate Course. 12th World Congress of Endoscopic Surgery. April 15, 2010

14,649

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

  • Main Page
  • Help
  • Create a New Wiki

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons