Laparoscopic mesh repair antireflux surgery for treatment of large hiatal hernia

Abstract

One of the most frequently occurring anatomic failures after laparoscopic fundoplication is migration of the wrap into the chest, with or without disruption. This so-called 'slipped' Nissen fundoplication may be the result of inadequate closure of the diaphragmatic crura or rupture of the sutures or disruption of the muscle fibers approached. From January 2000 to December 2002, a total of seven patients (four male) with a mean age of 56 years (range 22-72 years), were considered for laparoscopic antireflux procedure using DACRON mash to reinforce the crural hiatal closure. The patients were operated under general anesthesia; laparoscopy was performed by classical approach with five trocars. The mean operative time was 120 minutes (range 40-240 min). There were no deaths. The average of postoperative hospital stay was 3.5 days (range, 3-5). Patients returned to normal activities usually on postoperative day 10 (range, 7-15). The follow-up time was at least 2 years. There was only one late complication related to the use of DACRON mesh at the hiatus, due to migration of the mesh into the esophageal lumen causing disphagia. In conclusion the mesh repair antireflux surgery is a good alternative for closing the diaphragmatic defect in large hiatal hernias or to correct this problem in case of recurrence or Barrett's esophagus.

Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series

“…Dysphagia, weight loss, sepsis, abscess formation, and even esophagectomy may result [8][9][10][11][12][13][14][15][16][17][18]. This study represents the largest collection of mesh complications after prosthetic reinforcement of a hiatal hernia repair, and we report the first biological mesh complications at the hiatus.…”

Is a circular polypropylene mesh appropriate for application at the esophageal hiatus? Results from an experimental study in a porcine model

“…In accordance with this hypothesis, most cases of stenosis, migration, and erosion published in the clinical literature occurred with other types of meshes [1,2,7,8,10,15,33,35,37,41].…”

“…Polytetrafluorethylene, for example, is associated with less adhesion formation [31]. Accordingly, in 8 of 11 clinical publications known to us that report the material which provoked erosion of the esophagus, mesh reinforcement was done with polytetrafluorethylene [1,2,7,8,10,15,33,41].…”

Laparoscopic antireflux procedures with hepatic shoulder technique for the surgical management of large paraesophageal hernias and gastroesophageal reflux disease

“…All patients were followed up 8,9,11, and 15 months, respectively, after the procedure and did not report any recurrence of their symptoms. Three patients underwent an computerized abdominal tomography scan, which showed no recurrence of the hiatal hernia.…”