Skip to main content

Controversies Regarding Mesh Implantation for Hiatal Reinforcement in GERD and Hiatal Hernia Surgery

  • Chapter
  • First Online:
Management of Gastroesophageal Reflux Disease
  • 462 Accesses

Abstract

Many laparoscopic surgeons use mesh augmentation at the hiatus with nonresorbable or absorbable mesh currently. Substantial controversies are present, and surgical meetings often feature controversial discussions. Based on the available evidence, implantation of mesh in a regular GERD patient with a small to midsize hiatal hernia cannot be recommended as a routine procedure, since the advantages seem to be quite limited with recurrence and risk of long-term complication. In large hiatal hernias (>5 cm), current evidence and meta-analysis suggest that the use of a mesh can be considered, but the risk for complications is substantial and therefore the patient should be informed about these risks. Early results on bioabsorbable mesh are promising for reduction in early recurrence, but longer-term data is needed to determine the durability of the repair. In centers of antireflux surgery with a large experience in upper GI surgery, the use of a mesh may not reduce the necessity of revisional surgery even in large hiatal hernias. Therefore, the indication for mesh implantation should be tailored and focused to each individual patient. It is the opinion of the authors that permanent mesh should not be placed for hiatal reinforcement under any circumstance due to the potentially devastating consequences of erosion or frozen hiatus. Early reports of bioabsorbable mesh placement are promising, but require longer-term follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Altorki NK, Yankelevitz D, Skinner DB. Massive hiatal hernias: the anatomic basis of repair. J Thorac Cardiovasc Surg. 1998;115(4):828–35.

    CAS  PubMed  Google Scholar 

  2. Maziak DE, Todd TR, Pearson FG. Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg. 1998;115(1):53–60; discussion 61-2.

    CAS  PubMed  Google Scholar 

  3. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG. Laparoscopic repair of large type III hernia: objective followup reveals high recurrence rate. J Am Coll Surg. 2000;190:553–60.

    CAS  PubMed  Google Scholar 

  4. Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation? Ann Surg. 2002;236(4):492–500; discussion 500-501.

    PubMed  PubMed Central  Google Scholar 

  5. Draaisma WA, Gooszen HG, Tournoij E, Broeders IA. Controversies in paraesophageal hernia repair: a review of literature. Surg Endosc. 2005;19(10):1300–8.

    CAS  PubMed  Google Scholar 

  6. Stylopoulos N, Rattner DW. The history of hiatal hernia surgery: from Bowditch to laparoscopy. Ann Surg. 2005;241:185–93.

    PubMed  PubMed Central  Google Scholar 

  7. Furnée EJ, Draaisma WA, Broeders IA, Gooszen HG. Surgical reintervention after failed antireflux surgery; a systematic review of the literature. J Gastrointest Surg. 2009;13:1539–49.

    PubMed  PubMed Central  Google Scholar 

  8. Allison PR. Peptic ulcer of the oesophagus. Thorax. 1948;3(1):20–42.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. DeMeester TR. Etiology and natural history of gastroesophageal reflux disease and predictors of progressive disease. In: Yeo CJ, DeMeester SR, Mc Fadden DW, editors. Shackelford’s surgery of the alimentary tract. 8th ed. Philadelphia: Elsevier; 2019. p. 204–20.

    Google Scholar 

  10. DeMeester SR. Laparoscopic paraesophageal hernia repair: critical steps and adjunct techniques to minimize recurrence. Surg Laparosc Endosc Percutan Tech. 2013;23(5):429–35. https://doi.org/10.1097/SLE.0b013e3182a12716.

    Article  PubMed  Google Scholar 

  11. Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP. A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg. 2002;137(6):649–52.

    PubMed  Google Scholar 

  12. Granderath FA, Schweiger UM, Kamolz T, Pasiut M, Haas CF, Pointner R. Laparoscopic antireflux surgery with routine mesh-hiatoplasty in the treatment of gastroesophageal reflux disease. J Gastrointest Surg. 2002;6(3):347–53.

    PubMed  Google Scholar 

  13. Zilberstein B, Eshkenazy R, Pajecki D. Laparoscopic mesh repair antireflux surgery for treatment of large hiatal hernia. Dis Esophagus. 2005;18:166–9.

    CAS  PubMed  Google Scholar 

  14. Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg. 2005;140:40–8.

    PubMed  Google Scholar 

  15. Oelschlager BK, Pellegrini CA, Hunter JG, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom LL. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg. 2006;244:481–90.

    PubMed  PubMed Central  Google Scholar 

  16. Hawlasi A, Zonca S. Laparoscopic repair of paraesophageal hernia repair. JSLS. 1998;2:269–72.

    Google Scholar 

  17. Basso N, De Leo A, Genco A. 360° laparoscopic fundoplication with tension-free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease. Surg Endosc. 2000;14:164–9.

    CAS  PubMed  Google Scholar 

  18. Kamolz T, Bammer T, Wykypiel HJ, Pasuit M, Pointner R. Quality of life and surgical outcome after laparoscopic Nissen and Toupet fundoplication: one year follow up. Endoscopy. 2000;32:363–8.

    CAS  PubMed  Google Scholar 

  19. Granderath FA. Operative Therapie bei Hiatushernie. Der Chirurg: Evidenz zur Netzeinlage; 2017. https://doi.org/10.1007/s00104-016-0338-3.

    Book  Google Scholar 

  20. Champion JK, Rock D. Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc. 2003;17:551–3.

    CAS  PubMed  Google Scholar 

  21. Cassacia M, Torelli P, Panaro F. Laparoscopic tension-free repair of large paraesophageal hiatal hernias with a composite shaped mesh: two year follow-up. J Laparoendosc Adv Surg Tech. 2005;15:279–84.

    Google Scholar 

  22. Gryska PV, Vernon JK. Tension-free repair of hiatal hernia during laparoscopic fundoplication: a ten-year experience. Hernia. 2005;9:150–5.

    CAS  PubMed  Google Scholar 

  23. Ringley CD, Bochkarev V, Ahmed SI. Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience. Am J Surg. 2006;192:767–72.

    PubMed  Google Scholar 

  24. Granderath FA, Schweiger UM, Pointner R. Laparoscopic antireflux surgery: tailoring the hiatal closure to the size of hiatal surface area. Surg Endosc. 2007;21:542–8.

    CAS  PubMed  Google Scholar 

  25. Turkcapar A, Kepenekci I. Laparoscopic fundoplication with prosthetic hiatal closure. World J Surg. 2007;31:2169–76.

    PubMed  Google Scholar 

  26. Jacobs M, Gomez E, Plasencia G. Use of Surgisis mesh in laparoscopic repair of hiatal hernias. Surg Laparosc Endosc Percutan Tech. 2007;17:365–8.

    PubMed  Google Scholar 

  27. Lubezky N, Sagie B, Keidar A. Prosthetic mesh repair of large and recurrent diaphragmatic hernias. Surg Endosc. 2007;21:737–41.

    PubMed  Google Scholar 

  28. Zaninotto G, Portale G, Constantini M. Objective follow-up after laparoscopic repair of large type III hiatal hernia. Assessment of safety and durability. World J Surg. 2007;31:2177–83.

    PubMed  Google Scholar 

  29. Granderath FA, Granderath UM, Pointner R. Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg. 2008;32:999–1007.

    CAS  PubMed  Google Scholar 

  30. Hazebroek EJ, Ng A, Yong DHK. Clinical evaluation of laparoscopic repair of large hiatal hernias with TiMesh. ANZ J Surg. 2008;78:914–7.

    PubMed  Google Scholar 

  31. Lee YK, James E, Bochkarev V. Long-term outcome of cruroplasty reinforcement with human acellular dermal matrix in large paraesophageal hiatal hernia. J Gastrointest Surg. 2008;12:811–5.

    PubMed  Google Scholar 

  32. Müller-Stich BP, Linke GR, Borovicka J. Laparoscopic mesh-augmented hiatoplasty as a treatment of gastroesophageal reflux disease and hiatal hernias – preliminary clinical and functional results of a prospective case series. Am J Surg. 2008;195:749–56.

    PubMed  Google Scholar 

  33. Soricelli E, Basso N, Genco A. Long-term results of hiatal hernia mesh repair and antireflux laparoscopic surgery. Surg Endosc. 2009;23:2499–504.

    CAS  PubMed  Google Scholar 

  34. Zehetner J, Lipham JC, Ayazi S. A simplified technique for intrathoracic stomach laparoscopic fundoplication with Vicryl mesh and reinforcement. Surg Endosc. 2010;24:675–9.

    PubMed  Google Scholar 

  35. Antonakis F, Köckerling F, Kalinowski F. Functional results after repair of large hiatal hernia by use of a biologic mesh. Front Surg. 2016;3:16.

    PubMed  PubMed Central  Google Scholar 

  36. Koetje JH, Oor JE, Roks DJ, Van Westreenen HL, Hazebroek EJ, Nieuwenhuijs VB. Equal patient satisfaction, quality of life and objective recurrence rate after laparoscopic hiatal hernia repair with and without mesh. Surg Endosc. 2017; https://doi.org/10.1007/s00464-016-5405-9.

  37. Kemppainen E, Kiviluoto T. Fatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia. Surg Endosc. 2000;14:593.

    CAS  PubMed  Google Scholar 

  38. Coluccio G, Ponzio S, Ambu V. Dislocation into the cardial lumen of a PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia, a case report. Minerva Chir. 2000;55:341–5.

    CAS  PubMed  Google Scholar 

  39. Arendt T, Stuber E, Monig H, Folsch UR, Katsoulis S. Dysphagia due to transmural migration of surgical material into the esophagus nine years after Nissen fundoplication. Gastrointest Endosc. 2000;51:607–10.

    CAS  PubMed  Google Scholar 

  40. Targarona EM, Bendahan G, Balague C, Garriga J, Trias M. Mesh in the Hiatus A controversial issue. Arch Surg. 2004;139:1286–96.

    PubMed  Google Scholar 

  41. Rathore MA, Andrabi SIH, Bhatti MI, Najfi SMH, McMurray A. Meta analysis of recurrence after laparoscopic repair of paraesophageal Hernia. JSLS. 2007;11(4):456–60.

    PubMed  PubMed Central  Google Scholar 

  42. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ, Brunt LM, Hunter JG, DeMeester TR, Swanstrom LL, Smith CD, Filipi CJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009;23:1219–26.

    PubMed  Google Scholar 

  43. Parker M, Bowers SP, Bray JM, Harris AS, Belli EV, Pfluke JM, Preissler S, Asbun HJ, Smith CD. Hiatal mesh is associated with major resection at revisional operation. Surg Endosc. 2010;24(12):3095–10.

    PubMed  Google Scholar 

  44. Nandipati K, Bye M, Yamamoto SR, Pallati P, Lee T, Mittal SK. Reoperative intervention in patients with mesh at the hiatus is associated with high incidence of esophageal resection--a single-center experience. J Gastrointest Surg. 2013;17(12):2039–44. https://doi.org/10.1007/s11605-013-2361-8.

    Article  PubMed  Google Scholar 

  45. Fuchs KH. Revisionseingriffe nach Antirefluxchirurgie. In: Fuchs KH, editor. Management der Gastroösophagealen Refluxkrankeit. Berlin: De Gruyter Verlag; 2018. p. 183–208.

    Google Scholar 

  46. Fuchs KH, Babic B, Breithaupt W, Dallemagne B, Fingerhut A, Furnee E, Granderath F, Horvath P, Kardos P, Pointner R, Savarino E, Van Herwaarden-Lindeboom M, Zaninotto G. EAES recommendations for the management of gastroesophageal reflux disease. Surg Endosc. 2014;28(6):1753–73.

    PubMed  Google Scholar 

  47. Antoniou SA, Müller-Stich BP, Antoniou GA, Köhler G, Kuketina RR, Koch OO, Pointner R, Granderath FA. Laparoscopic augmentation of the diaphragmatic hiatus with biologic mesh versus suture repair: a systematic review and meta analysis. Langenbeck's Arch Surg. 2015;400:577–83.

    Google Scholar 

  48. Müller-Stich BP, Kenngott HG, Gondan M, Stock C, Linke GR, Fritz GR, Nickel F, Diener MK, Gutt CN, Wente M, Büchler MW, Fischer L. Use of Mesh in laparoscopic paraesophageal hernia repair: a meta-analysis and risk-benefit analysis. PLoS One. 2015;10(10):e0139547.

    PubMed  PubMed Central  Google Scholar 

  49. Tam V, Winger DG, Nason KS. A systematic review and metaanalysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg. 2016;211:226–38.

    PubMed  Google Scholar 

  50. Memon MA, Memon B, Yunus RM, Khan S. Suture Cruroplasty versus prosthetic hiatal herniorrhaphy for large hiatal hernia: a metaanalysis and systematic review of randomized controlled trials. Ann Surg. 2016;263:258–66.

    PubMed  Google Scholar 

  51. Huddy JR, Markar SR, Ni MZ, Morino M, Targarona EM, Zaninotto G, Hanna GB. Laparoscopic repair of hiatus hernia: does mesh type influence outcome? A meta-analysis and European survey study. Surg Endosc. 2016;30(12):5209–21.

    PubMed  Google Scholar 

  52. Zhang C, Liu D, Li F, Watson DI, Gao X, Koetje JH, Luo T, Yan C, Du X, Wang Z. Systematic review and metaanalysis of laparoscopic mesh versus suture repair of hiatus hernia: objective and subjective outcomes. Surg Endosc. 2017; https://doi.org/10.1007/s00464-017-5586-x.

  53. Grubnik VV, Malynovskyy AV. Laparoscopic repair of hiatal hernias: new classification supported by long-term results. Surg Endosc. 2013;27(11):4337–46. https://doi.org/10.1007/s00464-013-3069-2.

    Article  CAS  PubMed  Google Scholar 

  54. Antoniou SA, Pointner R, Granderath FA. Hiatal surface area as a basis for a new classification of hiatal hernia. Surg Endosc. 2014;28(4):1384–5. https://doi.org/10.1007/s00464-013-3292-x.

    Article  PubMed  Google Scholar 

  55. Müller-Stich BP, Senft JD, Lasitschka F, Shevchenko M, Billeter AT, Bruckner T, Kenngott HG, Fischer L, Gehring T. Polypropylene, polyester or polytetrafluoroethylene - is there an ideal material for mesh augmentation at the esophageal hiatus ? Results from an experimental study in a porcine model. Hernia. 2014;18:873–81.

    PubMed  Google Scholar 

  56. Oelschlager BK, Pellegrini CA, Hunter JG. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long- term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. 2011;213:461–8.

    PubMed  Google Scholar 

  57. Watson DI, Thompson SK, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG. Laparoscopic repair of very large Hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial. Ann Surg. 2015;261:282–9.

    PubMed  Google Scholar 

  58. Oor JE, Roks DJ, Koetje JH, Broeders JA, van Westreenen HL, Nieuwenhuijs VB, Hazebroek EJ. Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh. Surg Endosc. 2018;32(11):4579–89. https://doi.org/10.1007/s00464-018.

    Article  PubMed  Google Scholar 

  59. Van Rijn S, Roebroek YGM, Conchillo JM, Bouvy ND, Masclee AAM. Effect of Vagus nerve injury on the outcome of antireflux surgery: an extensive literature review. Dig Surg. 2016;33:230–9.

    PubMed  Google Scholar 

  60. Bhayani NH, Sharata AM, Dunst CM, Kurian AA, Reavis KM, Swanstrom LL. End of the road for dysfunctional end organ: laparoscopic gastrectomy for refractory gastroparesis. J Gastrointest Surg. 2015;19:411–7.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ryan C. Broderick .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Broderick, R.C. (2020). Controversies Regarding Mesh Implantation for Hiatal Reinforcement in GERD and Hiatal Hernia Surgery. In: Horgan, S., Fuchs, KH. (eds) Management of Gastroesophageal Reflux Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-48009-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-48009-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48008-0

  • Online ISBN: 978-3-030-48009-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics