Mesh-related complications in paraoesophageal repair: a systematic review

Spiro, Calista; Quarmby, Natalie; Gananadha, Siva

doi:10.1007/s00464-020-07723-0

Cited by 24 publications

(21 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Apparently surgeons had reservations about meshes due to the absence of clear recommendations in the guidelines (1,2) for the use of meshes in hiatoplasty and because of the increasing number of publications about, albeit rare but severe, mesh complications (28). Furthermore, a meta-analysis investigating the use of a mesh for large hiatal hernias contained only five randomized controlled trials (RCTs) with 478 patients (29).…”

Section: Discussionmentioning

confidence: 99%

What Is the Reality of Hiatal Hernia Management?—A Registry Analysis

et al. 2020

View full text Add to dashboard Cite

Introduction: To date, the guidelines for surgical repair of hiatal hernias do not contain any clear recommendations on the hiatoplasty technique with regard to the use of a mesh or to the type of fundoplication (Nissen vs. Toupet). This present 10-years analysis of data from the Herniamed Registry aims to investigate these questions. Methods: Data on 17,328 elective hiatal hernia repairs were entered into the Herniamed Registry between 01.01.2010 and 31.12.2019. 96.4% of all repairs were completed by laparoscopic technique. One-year follow-up was available for 11,280 of 13,859 (81.4%) patients operated during the years 2010-2018. The explorative Fisher's exact test was used for statistical calculation of significant differences with an alpha = 5%. Since the annual number of cases in the Herniamed Registry in the years 2010-2012 was still relatively low, to identify significant differences the years 2013 and 2019 were compared Results: The use of mesh hiatoplasty for axial and recurrent hiatal hernias remained stable over the years from 2013 to 2019 at 20 and 45%, respectively. In the same period the use of mesh hiatoplasty for paraesophageal hiatal hernia slightly, but significantly, increased from 33.0 to 38.9%. The proportion of Nissen and Toupet fundoplications for axial hiatal hernia repair dropped from 90.2% in 2013 to 74.0% in 2019 in favor of "other techniques" at 20.9%. For the paraesophageal hiatal hernias (types II-IV) the proportion of Nissen and Toupet fundoplications was 68.1% in 2013 and 66.0% in 2019. The paraesophageal hiatal hernia repairs included a proportion of gastropexy procedures of 21.7% in 2013 and 18.7% in 2019. The recurrent hiatal hernia repairs also included a proportion of gastropexies 12.8% in 2013 and 15.1% in 2019, Nissen and Toupet fundoplications of 72.7 and 62.7%, respectively, and "other techniques" of 14.5 and 22.2%, respectively. No changes were seen in the postoperative complication and recurrence rates. Conclusion: Clear trends are seen in hiatal hernia repair. The use of meshes has only slightly increased in paraesophageal hiatal hernia repairs. The use of alternative techniques has resulted in a reduction in the use of the "classic" Nissen and Toupet fundoplication surgical techniques.

show abstract

Section: Discussionmentioning

confidence: 99%

What Is the Reality of Hiatal Hernia Management?—A Registry Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In vivo testing of mesh devices is a vital step in preventing serious complications and with HH mesh, no complication is more serious than visceral erosion. Several recent literature reviews describe a variety of cases of hiatal mesh erosion and migration 7 , 8 and that such erosion is more common with the use of synthetic meshes. 7 It is perhaps reassuring then that the majority of HH studies in our work analysed the histological reaction between mesh and oesophagus.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent literature reviews describe a variety of cases of hiatal mesh erosion and migration 7 , 8 and that such erosion is more common with the use of synthetic meshes. 7 It is perhaps reassuring then that the majority of HH studies in our work analysed the histological reaction between mesh and oesophagus. Surgeons continue to explore ways of avoiding such complications including the use of a bioresorbable mesh 22 or novel techniques such as those described by Braghetto et al 23 .…”

Section: Discussionmentioning

confidence: 99%

“…Whether or not mesh augmentation is helpful, its use is certainly associated with complications such as migration and erosion. 7 , 8 Reviews of the literature have highlighted a variety of ways to manage such complications, some resulting in gastrectomy or oesophagectomy. Whilst such complications are not an issue for congenital DH repair, other problems such as recurrence and visceral adhesions may have serious consequences given the young patient cohort.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review Examining the Experimental Methodology Behind In Vivo Testing of Hiatus Hernia and Diaphragmatic Hernia Mesh

Whitehead-Clarke

Beynon

Banks

et al. 2022

Journal of Gastrointestinal Surgery

View full text Add to dashboard Cite

Introduction Mesh implants are regularly used to help repair both hiatus hernias (HH) and diaphragmatic hernias (DH). In vivo studies are used to test not only mesh safety, but increasingly comparative efficacy. Our work examines the field of in vivo mesh testing for HH and DH models to establish current practices and standards. Method This systematic review was registered with PROSPERO. Medline and Embase databases were searched for relevant in vivo studies. Forty-four articles were identified and underwent abstract review, where 22 were excluded. Four further studies were excluded after full-text review—leaving 18 to undergo data extraction. Results Of 18 studies identified, 9 used an in vivo HH model and 9 a DH model. Five studies undertook mechanical testing on tissue samples—all uniaxial in nature. Testing strip widths ranged from 1–20 mm (median 3 mm). Testing speeds varied from 1.5–60 mm/minute. Upon histology, the most commonly assessed structural and cellular factors were neovascularisation and macrophages respectively (n = 9 each). Structural analysis was mostly qualitative, where cellular analysis was equally likely to be quantitative. Eleven studies assessed adhesion formation, of which 8 used one of four scoring systems. Eight studies measured mesh shrinkage. Discussion In vivo studies assessing mesh for HH and DH repair are uncommon. Within this relatively young field, we encourage surgical and materials testing institutions to discuss its standardisation.

show abstract

“…Ebenfalls wird allerdings vor allem kasuistisch das Auftreten von Erosionen durch die eingesetzten Netze beschrieben [23, 28 -30]. In einem 2020 publizierten Review über Komplikationen nach netzverstärkter Hiatoplastik zeigte sich die befürchtete Ösophaguserosion als eine sehr seltene Komplikation, die mehr bei dem Einsatz von synthetischen Netzen auftritt und bei der Revisionsoperation bis zu einer Ösophagektomie führen kann [30]. Eine weitere seltene aber schwerwiegende Komplikation, die vor allem bei der Fixierung des Netzes auftreten kann, ist die Perikardtamponade, mit mehrfach berichteten tödlichen Verläufen [31 -33].…”

Section: Netzaugmentation Bei Der Hiatusrekonstruktionunclassified

Netzimplantation bei der Chirurgie der Hiatushernie und bei der Anti-Reflux-Chirurgie – Kontra-Statement

Kuvendjiska

Hoeppner

2021

Zentralbl Chir

View full text Add to dashboard Cite

ZusammenfassungBei der chirurgischen Behandlung der gastroösophagealen Refluxerkrankung und der operativen Behandlung von Hiatushernien ist die hohe Rezidivrate der Hiatushernie ein zentrales Problem. Vor diesem Hintergrund werden zur Augmentation des Nahtverschlusses am Hiatus oesophageus verschiedene alloplastische Netze eingesetzt. Es wurden in der Vergangenheit sehr unterschiedliche Ergebnisse berichtet und der Einsatz von Netzen bei der Hiatusrekonstruktion wurde kontrovers diskutiert. Im Vordergrund stehen neben der Rezidivhäufigkeit auch immer wieder Berichte über Komplikationen der Hiatusaugmentation durch alloplastische Netze. Die heutige Datenlage zeigt auf der Grundlage von mehreren prospektiv randomisierten, doppelt verblindeten Vergleichsstudien und von Metaanalysen (Klasse-Ia- und -Ib-Evidenz) keine Vorteile der netzaugmentierten Hiatoplastik für die Verhinderung des Hiatushernienrezidivs. Sie beschreibt gleichzeitig mehr langfristige postoperative Komplikationen – vor allem von Dysphagie – beim Einsatz von Netzen für die Hiatusrekonstruktion. Vom routinemäßigen Einsatz der Netzaugmentation bei der Hiatusrekonstruktion muss daher aktuell abgeraten werden.

show abstract

Mesh-related complications in paraoesophageal repair: a systematic review

Cited by 24 publications

References 74 publications

What Is the Reality of Hiatal Hernia Management?—A Registry Analysis

What Is the Reality of Hiatal Hernia Management?—A Registry Analysis

A Systematic Review Examining the Experimental Methodology Behind In Vivo Testing of Hiatus Hernia and Diaphragmatic Hernia Mesh

Netzimplantation bei der Chirurgie der Hiatushernie und bei der Anti-Reflux-Chirurgie – Kontra-Statement

Contact Info

Product

Resources

About