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Severe complication of laparoscopic mesh hiatoplasty for paraesophageal hernia

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Abstract

Background

Several studies have shown that laparoscopic hernia repair for large paraesophageal hiatal hernia is associated with a high recurrence rate. Therefore, some authors recommend the use of prosthetic meshes. Considering the dynamic area between the esophagus and the diaphragmatic crura with its constant motion, it is astonishing that only a minor number of surgeons describe mesh-associated complications.

Methods

Between January 2000 and August 2008, 26 patients of the Centre Hospitalier Emile Mayrisch (CHEM, Luxembourg) underwent laparoscopic repair for large paraesophageal hiatal hernia (median age, 70 (range, 39–90) years). In nine patients, prosthetic mesh reinforcement was performed (7 composite/2 mono-phase mesh). Crural repair without tension was performed only with sutures. There were no conversions. Follow-up assessment was prospective with the GIQL (Gastro-Intestinal Quality of Life) Index.

Results

Responses to the GIQLI questionnaires were obtained from 20 patients (6 died of unrelated causes). Nineteen patients were satisfied with their symptom control 1 year after the operation (GIQLI 127). Sixteen patients had radiological follow-up (median, 24 months). Three patients treated without mesh (3/10) showed a radiological recurrence. All of them (3/10) had symptoms. None of the controlled patients with mesh (0/6) showed a recurrence. One patient developed a severe aortal bleeding 1, 2, and 3 weeks after the laparoscopic mono-phase mesh repair. During conventional operation, the bleeding stopped. Three years later, the follow-up showed a satisfied patient (GIQLI 127).

Conclusions

In view of the described complication, there is still considerable controversy regarding the routine use of mesh. To increase safety, a composite mesh should be preferred.

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Authors and Affiliations

  1. General and Visceral Surgery Unit, Centre Hospitalier Emile Mayrisch (CHEM), Rue Emile Mayrisch, 4005, Esch-sur-Alzette, Luxembourg

    Nico Zügel & Martin Kox

  2. Department of Surgery, University of Munich, Klinikum Grosshadern, Marchioninistr. 15, 81377, Munich, Germany

    Nico Zügel, Reinhold A. Lang & Thomas P. Hüttl

Authors
  1. Nico Zügel
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  2. Reinhold A. Lang
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  3. Martin Kox
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  4. Thomas P. Hüttl
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Correspondence to Nico Zügel.

Additional information

Nico Zügel and Reinhold A. Lang contributed equally to this work.

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Zügel, N., Lang, R.A., Kox, M. et al. Severe complication of laparoscopic mesh hiatoplasty for paraesophageal hernia. Surg Endosc 23, 2563–2567 (2009). https://doi.org/10.1007/s00464-009-0456-9

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  • DOI: https://doi.org/10.1007/s00464-009-0456-9

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