Laparoscopic Hiatal hernia Repair: Preventing recurrence avoiding Esophageal erosion, ¿Mesh or no Mesh that is the question?
Abstract
Introduction: Paraesophageal hernias represents 5 to 10% of all hernias. The use of mesh in hiatal hernia repair has shown to lower recurrence rates. Frantzides et al. report a complication incidence such as esophageal erosion in up to 10.1% of patients. Sathasivam et al. report similar results using polypropylene and polytetrafluoroethylene. Currently covered polyester meshes with collagen are available offering an alternative option to reduce these complications. This manuscript describes a case series using laparoscopic giant hiatal hernia repair using this modified mesh. Recurrence rates are analysed to determine benefits vs risks using this surgical approach.
Methods: This is a retrospective descriptive study from November 2013 to February 2017, twenty-four patients suffering from symptomatic grade III – IV giant hiatal hernias were taken to laparoscopic hernia repair using polyester collagen covered mesh (Parietex Composite HiatalR).
Results: From November 2013 through February 2017, a total of 24 patients were included in this series, 22 were programmed surgeries and two emergency surgery due to a gastric volvulus. All procedures were laparoscopic. Average surgery time was 92.6 minutes and average hospital stay was 26 hours. At 36 months postoperative, one patient suffered an esophageal mesh erosion (incidence of 4.1%) requiring a distal esophagectomy, proximal gastrectomy and gastric tube reconstruction.
Conclusion: The use of mesh in laparoscopic paraesophageal hernia repair should be routine in order to reduce the maximum hernia recurrence, however as evidenced in our study it has not been designed an ideal mesh for esophageal hiatus.
Key words: Paraesophageal hernias, mesh, laparoscopic, hiatus.
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