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Hiatal hernia repair with mesh: a survey of SAGES members

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Abstract

Background

Primary repair of large hiatal hernia is associated with a high recurrence rate. The use of mesh may reduce this recurrence rate. The indication for mesh use, the type of mesh to use, and the placement technique are controversial. A survey of surgeon practice was undertaken to obtain a better understanding of the controversies surrounding this clinical problem.

Methods

A questionnaire on the technique and results of mesh hiatal herniorrhaphy was sent to 1,192 members of the Society of Gastrointestinal and Endoscopic Surgeons (SAGES).

Results

There were 275 responses; 261 of these were analyzed. A total of 5,486 hiatal hernia repairs with mesh were reported; 77% and 23% were performed laparoscopically vs open, respectively. The most common indication for mesh usage was an increased size hiatal defect (46% of respondents). The most common mesh types were biomaterial (28%), polytetrafluoroethylene (25%), and polypropylene (21%). Suture anchorage was the most common fixation technique (56% of respondents). The findings showed a failure rate of 3%, a stricture rate of 0.2%, and an erosion rate of 0.3%. Biomaterial tended to be associated with failure, whereas nonabsorbable mesh tended to be associated with stricture and erosion.

Conclusions

The use of mesh during hiatal hernia repair resulted in a reported recurrence rate which appeared to be lower than that obtained historically without mesh. No one mesh type was clearly superior in terms of avoiding failure and complication.

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Acknowledgments

This study was supported with the resources and facilities of the Omaha VA Medical Center and the Chicago Institute of Minimally Invasive Surgery. The authors acknowledge Valerie K. Shostrom of the Department of Biostatistics at the University of Nebraska Medical Center for assistance with statistical testing.

Disclosures

Drs. Frantzides, Carlson, Loizides, Papafili, Lu, Roberts, Zeni, Frantzides have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA

    Constantine T. Frantzides

  2. Chicago Institute of Minimally Invasive Surgery, Skokie, IL, USA

    Constantine T. Frantzides, Sofronis Loizides, Anastasia Papafili, Mihn Luu, Jacob Roberts, Tallal Zeni & Alexander Frantzides

  3. Department of Surgery, University of Nebraska Medical Center and Surgery 112, Omaha VA Medical Center, 4101 Woolworth Avenue, Omaha, NE, 68105, USA

    Mark A. Carlson

  4. Royal Free Hospital, London, UK

    Sofronis Loizides & Anastasia Papafili

  5. Michigan Bariatric Institute and St. Mary Mercy Hospital, Livonia, MI, USA

    Tallal Zeni

Authors
  1. Constantine T. Frantzides
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  2. Mark A. Carlson
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  3. Sofronis Loizides
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  4. Anastasia Papafili
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  7. Tallal Zeni
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  8. Alexander Frantzides
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Correspondence to Mark A. Carlson.

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Frantzides, C.T., Carlson, M.A., Loizides, S. et al. Hiatal hernia repair with mesh: a survey of SAGES members. Surg Endosc 24, 1017–1024 (2010). https://doi.org/10.1007/s00464-009-0718-6

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  • DOI: https://doi.org/10.1007/s00464-009-0718-6

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