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

Stadlhuber, Rudolf J.; Sherif, Amr El; Mittal, Sumeet K.; Fitzgibbons, Robert J.; Brunt, L. Michael; Hunter, John G.; DeMeester, Tom R.; Swanström, Lee L.; Smith, C. Daniel; Filipi, Charles J.

doi:10.1007/s00464-008-0205-5

Cited by 353 publications

(239 citation statements)

References 35 publications

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“…16 There is also concern with the rare but problematic complication of mesh erosion and high risk of resection when refashioning in the presence of previous mesh. 29 Short oesophagus was probably rare in this study owing to the lack of stricture cases and nearly 30 years of availability of potent acid suppression, largely eliminating the short oesophagus. The Collis operations were done in a trial situation and did not reflect inability to reduce the cardio-oesophageal junction into the abdomen so no 'real' cases were found in the 455 procedures.…”

Section: Discussionmentioning

confidence: 80%

Durability of giant hiatus hernia repair in 455 patients over 20 years

Page

Furtado

Hayward

et al. 2015

annals

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INTRODUCTION The surgical management of symptomatic giant hiatus hernia (GHH) aims to improve quality of life (QoL) and reduce the risk of life threatening complications. Previous reports are predominantly those with small sample sizes and short follow-up periods. The present study sought to assess a large cohort of patients for recurrence and QoL over a longer time period. METHODS This was a follow-up study of a prospectively collected database of 455 consecutive patients. Primary repair of GHH was evaluated by endoscopy/barium meal for recurrence and a standardised symptom questionnaire for QoL. Recurrence was assessed for size, elapsed time, oesophagitis and symptoms. RESULTS Objective and subjective review was achieved in 91.9% and 68.6% of patients. The median age was 69 years (range: 15-93 years) and 64% were female. Laparoscopic repair was completed in 95% (mesh in 6% and Collis gastroplasty in 7%). The 30-day mortality rate was 0.9%. The proportion of patients alive at five and ten years were 90% and 75% respectively. Postoperative QoL scores improved from a mean of 95 to 111 (p<0.01) and were stable over time (112 at 10 years).The overall recurrence rate was 35.6% (149/418) at 42 months; this was 11.5% (48/418) for hernias >2cm and 24.2% (101/418) for <2cm. The rate of new recurrence at 0-1 years was 13.7% (>2cm = 3.4%, <2cm = 10.3%), at 1-5 years it was 30.8% (>2cm = 9.5%, <2cm = 21.3%), at 5-10 years it was 40.1% (>2cm = 13.8%, <2cm = 26.3%) and at over 10 years it was 50.0% (>2cm = 25.0%, <2cm = 25.0%). Recurrence was associated with oesophagitis but not decreased QoL. Revision surgery was required in 4.8% of cases (14.8% with recurrence). There were no interval major GHH complications. CONCLUSIONS Surgery has provided sustained QoL improvements irrespective of recurrence. Recurrence occurred progressively over ten years and may predispose to oesophagitis.

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Section: Discussionmentioning

confidence: 80%

Durability of giant hiatus hernia repair in 455 patients over 20 years

Page

Furtado

Hayward

et al. 2015

annals

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“…This is also demonstrated by Novitsky and Rosen [1] reporting on all the different types of biological meshes and their different properties. Meshes working differently in different positions have also been illustrated by Stadlhuber et al [3] who reported of several cases of esophageal stenosis/erosion from the use of both synthetic and biological meshes for the reinforcement of the crural closure during hiatal hernia repair. In this issue of Hernia, however, Powell et al [4] illustrate that another group of meshes, namely the ''synthetic remodeling meshes'' seem to work without complications in the early phase in 70 patients who underwent hiatal repair.…”

Section: The Concept Of Biologic Meshesmentioning

confidence: 93%

The battle between biological and synthetic meshes in ventral hernia repair

Montgomery

2013

Hernia

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“…(33) Proponents of the mesh cite lower hernia recurrence rates, while opponents cite the occurrence of complications such as dysphagia, oesophageal stenosis and erosion of the mesh into the oesophagus. (34,35) In the present study, the dissected hernia sac was routinely used as an interposition between the mesh and oesophagus to reduce the risk of erosion; there were no cases of recurrence, mesh erosion or dysphagia among the patients who received mesh implants.…”

Section: Discussionmentioning

confidence: 80%