Abstract
Background
Biologic mesh is widely used for repair of large, complicated hiatal hernias. Recently, there have been reports of complications after its implantation. We studied the course of a large group of patients who had undergone hiatal hernia repair with use of biologic mesh to determine the rate of immediate and late complications related to its use.
Methods
All patients who had biologic mesh placed at the hiatus and who had been followed for at least 1 year were included. Perioperative data were reviewed, and a questionnaire was administered, designed to identify symptoms of gastroesophageal reflux, other symptoms such as dysphagia, and all other operative or endoscopic interventions that occurred after mesh implantation. In addition, postoperative radiologic and endoscopic studies were reviewed to assess signs of complications related to use of mesh.
Results
There were 126 patients eligible for the study. We were able to contact 73 of these patients, at median follow-up of 45 months. No mesh-related complications were found. The frequency and severity of heartburn, regurgitation, and dysphagia improved significantly compared with preoperative values, and 89% of the patients reported good to excellent results in terms of overall satisfaction. Six patients recorded worsening of dysphagia postoperatively, but after careful work-up and review of each individual case, no case seemed to be directly related to the mesh. No erosions, strictures, or other complications directly related to use of mesh were found. One patient required reoperation due to hiatal hernia recurrence with gastroesophageal reflux disease (GERD) symptoms.
Conclusions
Use of biologic mesh for laparoscopic repair of large, complicated hiatal hernias appears safe. There were no major complications related to the mesh, and overall satisfaction with the operation was very good.
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Disclosures
Authors Eelco B. Wassenaar and Rebecca P. Petersen have funding of their fellowships through Covidien. Authors Fernando Mier, Huseyin Sinan, and Valeria Martin have no conflicts of interest or financial ties to disclose. Author Carlos A. Pellegrini receives research grants from Cook Biotech, Inc., and Stryker and serves on the scientific advisory board of Torax, and his wife is employed by Covidien. Author Brant K. Oelschlager receives research grants from Cook Biotech, Inc., W.L. Gore, Torax Medical, Synovis Surgical Innovations, and Takeda Pharmaceuticals, receives an education grant and does consulting for Covidien, and is on the speakers bureau of Endogastric Solutions.
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Wassenaar, E.B., Mier, F., Sinan, H. et al. The safety of biologic mesh for laparoscopic repair of large, complicated hiatal hernia. Surg Endosc 26, 1390–1396 (2012). https://doi.org/10.1007/s00464-011-2045-y
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DOI: https://doi.org/10.1007/s00464-011-2045-y