Paraesophageal Hernia Repair with Biomesh Does Not Increase Postoperative Dysphagia
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- Goers, T.A., Cassera, M.A., Dunst, C.M. et al. J Gastrointest Surg (2011) 15: 1743. doi:10.1007/s11605-011-1596-5
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Laparoscopic techniques have led to hiatal procedures being performed with less morbidity but higher failure rates. Biologic mesh (biomesh) has been proposed as an alternative to plastic mesh to achieve durable repairs while minimizing stricturing and erosion. This paper documents the lack of significant dysphagia after the placement of biomesh during hiatal hernia repair.
A retrospective chart review of patients who underwent paraesophageal hiatal hernia repairs with and without biomesh was performed. Hernias were diagnosed with esophagogastroscopy and esophageal manometry. Demographic, procedural, and pre- and post-surgery symptom data were recorded.
Fifty-six patients underwent biomesh repair while 33 patients underwent non-mesh repairs. The procedure time for mesh repairs was significantly longer (p = 0.004). Hospital stays, resting lower esophageal sphincter pressure, and mean contraction amplitudes were similar between groups. Residual pressure was measured to be significantly higher in patients who had mesh repairs (p = 0.0001). Normal esophageal peristalsis was maintained in both groups. At first follow-up, mesh patients complained of more dysphagia and bloating, but non-mesh patients had more heartburn. At second follow-up, non-mesh patients had more symptom complaints than mesh patients.
The addition of biomesh for hiatal hernia repair does not result in significantly increased patient dysphagia rates postoperatively compared with patients who underwent primary repair.