Surgical Endoscopy

, Volume 23, Issue 6, pp 1219–1226 | Cite as

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

  • Rudolf J. Stadlhuber
  • Amr El Sherif
  • Sumeet K. Mittal
  • Robert J. FitzgibbonsJr
  • L. Michael Brunt
  • John G. Hunter
  • Tom R. DeMeester
  • Lee L. Swanstrom
  • C. Daniel Smith
  • Charles J. Filipi



Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0–24%). However, mesh complications have been observed.


We compiled two cases, and our senior author contacted other experienced esophageal surgeons who provided 26 additional cases with mesh-related complications. Care was taken to retrieve technical operative details concerning mesh size and shape and implantation technique used.


Twenty-six patients underwent laparoscopic and two patients open surgery for large hiatal hernia (n = 28). Twenty-five patients had a concomitant Nissen fundoplication, two a Toupet fundoplication, and one a Watson fundoplication. Mesh types placed were polypropylene (n = 8), polytetrafluoroethylene (PTFE) (n = 12), biological mesh (n = 7), and dual mesh (n = 1). Presenting symptoms associated with mesh complications were dysphagia (n = 22), heartburn (n = 10), chest pain (n = 14), fever (n = 1), epigastric pain (n = 2), and weight loss (n = 4). Main reoperative findings were intraluminal mesh erosion (n = 17), esophageal stenosis (n = 6), and dense fibrosis (n = 5). Six patients required esophagectomy, two patients had partial gastrectomy, and 1 patient had total gastrectomy. Five patients did not require surgery. In this group one patient had mesh removal by endoscopy. There was no immediate postoperative mortality, however one patient has severe gastroparesis and five patients are dependent on tube feeding. Two patients died 3 months postoperatively of unknown cause. There is no apparent relationship between mesh type and configuration with the complications encountered.


Complications related to synthetic mesh placement at the esophageal hiatus are more common than previously reported. Multicenter prospective studies are needed to determine the best method and type of mesh for implantation.


Hiatal hernia Mesh Prosthetic hiatoplasty Esophageal perforation Mesh erosion 


  1. 1.
    El Sherif A, Yano F, Mittal S, Filipi CJ (2006) Collagen metabolism and recurrent hiatal hernia: cause and effect? Hernia 10:511–520PubMedCrossRefGoogle Scholar
  2. 2.
    Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 190:553–560PubMedCrossRefGoogle Scholar
  3. 3.
    Luostarinen M, Rantalainen M, Helve O, Reinikainen P, Isolauri J (1998) Late results of paraoesophageal hiatus hernia repair with fundoplication. Br J Surg 85:272–275PubMedCrossRefGoogle Scholar
  4. 4.
    Tierney BJ, Iqbal A, Awad Z, Penka W, Filipi CJ, Mittal SK (2006) Sub-diaphragmatic fascia: role in the recurrence of hiatal hernias. Dis Esophagus 19:111–113PubMedCrossRefGoogle Scholar
  5. 5.
    Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs. simple cruroplasty for large hiatal hernia. Arch Surg 137:649–652PubMedCrossRefGoogle Scholar
  6. 6.
    Wu JS, Dunnegan DL, Soper NJ (1999) Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair. Surg Endosc 13:497–502PubMedCrossRefGoogle Scholar
  7. 7.
    Targarona EM, Bendahan G, Balague C, Garriga J, Trias M (2004) Mesh in the hiatus: a controversial issue. Arch Surg 139:1286–1296PubMedCrossRefGoogle Scholar
  8. 8.
    Carlson MA, Condon RE, Ludwig KA, Schulte WJ (1998) Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 187:227–230PubMedCrossRefGoogle Scholar
  9. 9.
    Casabella F, Sinanan M, Horgan S, Pellegrini CA (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 171:485–489PubMedCrossRefGoogle Scholar
  10. 10.
    Coluccio G, Ponzio S, Ambu V, Tramontano R, Cuomo G (2000) Dislocation into the cardial lumen of a PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia, A case report. Minerva Chir 55:341–345PubMedGoogle Scholar
  11. 11.
    Dutta S (2007) Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery. J Pediatr Surg 42:252–256PubMedCrossRefGoogle Scholar
  12. 12.
    Edelman DS (1995) Laparoscopic paraesophageal hernia repair with mesh. Surg Laparosc Endosc 5:32–37PubMedGoogle Scholar
  13. 13.
    Gajbhiye R, Quraishi AH, Mahajan P, Warhadpande M (2005) Dysphagia due to transmural migration of polypropylene mesh into esophagus. Indian J Gastroenterol 24:226–227PubMedGoogle Scholar
  14. 14.
    Griffith PS, Valenti V, Qurashi K, Martinez-Isla A (2008) Rejection of goretex mesh used in prosthetic cruroplasty. Int J Surg. Jan 29 [Epub ahead of print]Google Scholar
  15. 15.
    Schauer PR, Ikramuddin S, McLaughlin RH, Graham TO, Slivka A, Lee KK, Schraut WH, Luketich JD (1998) Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg 176:659–665PubMedCrossRefGoogle Scholar
  16. 16.
    Trus TL, Bax T, Richardson WS, Branum GD, Mauren SJ, Swanstrom LL, Hunter JG (1997) Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1:221–227PubMedCrossRefGoogle Scholar
  17. 17.
    van der Peet DL, Klinkenberg-Knol EC, Alonso Poza A, Sietses C, Eijsbouts QA, Cuesta MA (2000) Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment. Surg Endosc 14:1015–1018PubMedCrossRefGoogle Scholar
  18. 18.
    Zilberstein B, Eshkenazy R, Pajecki D, Granja C, Brito AC (2005) Laparoscopic mesh repair antireflux surgery for treatment of large hiatal hernia. Dis Esophagus 18:166–169PubMedCrossRefGoogle Scholar
  19. 19.
    Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140:40–48PubMedCrossRefGoogle Scholar
  20. 20.
    Gryska PV, Vernon JK (2005) Tension-free repair of hiatal hernia during laparoscopic fundoplication: a ten-year experience. Hernia 9:150–155PubMedCrossRefGoogle Scholar
  21. 21.
    Müller-Stich BP, Holzinger F, Kapp T, Klaiber C (2006) Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement. Surg Endosc 20:380–384PubMedCrossRefGoogle Scholar
  22. 22.
    Oelschlager BK, Pelligrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair—a multicenter, prospective randomized trial. Ann Surg 244:481–490PubMedGoogle Scholar
  23. 23.
    Jacobs M, Gomez E, Plasencia G, Lopez-Penalver C, Lujan H, Velarde D, Jessee T (2007) Use of surgisis mesh in laparoscopic repair of hiatal hernias. Surg Laparosc Endosc Percutan Tech 17:365–368PubMedCrossRefGoogle Scholar
  24. 24.
    Jansen M, Otto J, Jansen PL, Anurov M, Titkova S, Willis S, Rosch R, Ottinger A, Schumpelick V (2007) Mesh migration into the esophageal wall after mesh hiatoplasty: comparison of two alloplastic materials. Surg Endosc 21:2298–2303PubMedCrossRefGoogle Scholar
  25. 25.
    Desai KM, Diaz S, Dorward IG, Winslow ER, La Regina MC, Halpin V, Soper NJ (2006) Histologic results 1 year after bioprosthetic repair of paraesophageal hernia in a canine model. Surg Endosc 20:1693–1697PubMedCrossRefGoogle Scholar
  26. 26.
    Varshney S, Kelly JJ, Branagan G, Somers SS, Kelly JM (2002) Angelchik prosthesis revisited. World J Surg 26:129–133PubMedCrossRefGoogle Scholar
  27. 27.
    Maxwell-Armstrong CA, Steele RJ, Amar SS, Evans D, Morris DL, Foster GE, Hardcastle JD (1997) Long-term results of the Angelchik prosthesis for gastro-oesophageal reflux. Br J Surg 84:862–864PubMedCrossRefGoogle Scholar
  28. 28.
    Carbonell AM, Maher JW (2006) Laparoscopic transgastric removal of an eroded Angelchik prosthesis. Am Surg 72:724–726PubMedGoogle Scholar
  29. 29.
    Florez DA, Howington JA, Long JD (2003) Esophageal obstruction secondary to erosion of an Angelchik prosthesis: the role of endoscopic management. Gastrointest Endosc 58:624–626PubMedGoogle Scholar
  30. 30.
    Purkiss SF, Argano VA, Kuo J, Lewis CT (1992) Oesophageal erosion of an Angelchik prosthesis: surgical management using fundoplication. Eur J Cardiothorac Surg 6:517–518PubMedCrossRefGoogle Scholar
  31. 31.
    Jakaite D, Gourley GR, Pellett JR (1991) Erosions of the angelchik prosthesis in pediatric-sized developmentally disabled patients. J Pediatr Gastroenterol Nutr 13:186–191PubMedCrossRefGoogle Scholar
  32. 32.
    Cullingford GL, Coffey JF, Carr-Locke DL (1990) Endoscopic management of intragastric migration of an Angelchik prosthesis. Aust N Z J Surg 60:913–917PubMedCrossRefGoogle Scholar
  33. 33.
    Kauten JR, Mansour KA (1986) Complications of the Angelchik prosthesis in the management of gastroesophageal reflux. Am Surg 52:208–213PubMedGoogle Scholar
  34. 34.
    Lilly MP, Slafsky SF, Thompson WR (1984) Intraluminal erosion and migration of the Angelchik antireflux prosthesis. Arch Surg 119:849–853PubMedGoogle Scholar
  35. 35.
    Benjamin SB, Kerr R, Cohen D, Motaparthy V, Castell DO (1984) Complications of the Angelchik antireflux prosthesis. Ann Intern Med 100:570–575PubMedGoogle Scholar
  36. 36.
    Lattuada E, Zappa MA, Mozzi E, Fichera G, Granelli P, De Ruberto F, Antonini I, Radaelli S, Roviaro G (2007) Band erosion following gastric banding: how to treat it. Obes Surg 17:329–333PubMedCrossRefGoogle Scholar
  37. 37.
    Bueter M, Thalheimer A, Meyer D, Fein M (2006) Band erosion and passage, causing small bowel obstruction. Obes Surg 16:1679–1682PubMedCrossRefGoogle Scholar
  38. 38.
    Baladas HG, Smith GS, Richardson MA, Dempsey MB, Falk GL (2000) Esophagogastric fistula secondary to teflon pledget: a rare complication following laparoscopic fundoplication. Dis Esophagus 13:72–74PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Rudolf J. Stadlhuber
    • 1
  • Amr El Sherif
    • 1
  • Sumeet K. Mittal
    • 1
  • Robert J. FitzgibbonsJr
    • 1
  • L. Michael Brunt
    • 2
  • John G. Hunter
    • 3
  • Tom R. DeMeester
    • 4
  • Lee L. Swanstrom
    • 5
  • C. Daniel Smith
    • 6
  • Charles J. Filipi
    • 1
  1. 1.Department of SurgeryCreighton University School of MedicineOmahaUSA
  2. 2.Washington University School of MedicineSt LouisUSA
  3. 3.Department of SurgeryOregon Health & Science UniversityPortlandUSA
  4. 4.Department of SurgeryKeck School of Medicine of USCLos AngelesUSA
  5. 5.Department of SurgeryOregon ClinicPortlandUSA
  6. 6.Department of SurgeryMayo ClinicJacksonvilleUSA

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