Abstract
Paraesophageal hernia repair has been associated with a recurrence rate of up to 42%. Thus, in the last decade, there has been increasing interest in the use of mesh reinforcement of the hiatal repair. Polytetrafluoroethylene (PTFE) is one of the materials that have been used for this purpose, as it is thought to induce minimal tissue reaction. We report two cases in which complications specific to the use of PTFE mesh in this location developed over time. In the first patient, a gastrectomy was required to remove a large PTFE mesh which had eroded into the esophagogastric junction and gastric cardia. The second patient experienced severe dysphagia resulting from a stricture caused by the implant, requiring removal of the mesh. Although such complications have only rarely been reported, the severity and consequences of these incidents, as reported in the literature and in light of our observations, suggest that an alternative to PTFE should be considered for crural reinforcement during paraesophageal hernia repair.
This is a preview of subscription content, log in via an institution to check access.
References
Pitcher DE, Curet MJ, Martin DT, et al. Successful laparoscopic repair of paraesophageal hernia. Arch Surg 1995;130(6):590–596.
Casabella F, Sinanan M, Horgan S, Pellegrini CA. Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 1996;171(5):485–489.
Hashemi M, Peters JH, DeMeester TR, et al. Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 2000;190(5):553–560; discussion 560–561.
Shulman AG, Amid PK, Lichtenstein IL. The safety of mesh repair for primary inguinal hernias: results of 3,019 operations from five diverse surgical sources. Am Surg 1992;58(4):255–257.
Awad ZT, Puri V, LeBlanc K, et al. Mechanisms of ventral hernia recurrence after mesh repair and a new proposed classification. J Am Coll Surg 2005;201(1):132–140.
Johnson JM, Carbonell AM, Carmody BJ, et al. Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications: a critical analysis of the available literature. Surg Endosc 2006;20(3):362–366.
Targarona EM, Bendahan G, Balague C, et al. Mesh in the hiatus: a controversial issue. Arch Surg 2004;139(12):1286–1296; discussion 1296.
Trus TL, Bax T, Richardson WS, et al. Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1997;1(3):221–227; discussion 228.
Coluccio G, Ponzio S, Ambu V, et al. 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(5):341–345.
Champion JK, Rock D. Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 2003;17(4):551–553.
Matthews BD, Pratt BL, Pollinger HS, et al. Assessment of adhesion formation to intra-abdominal polypropylene mesh and polytetrafluoroethylene mesh. J Surg Res 2003;114(2):126–132.
Matthews BD, Mostafa G, Carbonell AM, et al. Evaluation of adhesion formation and host tissue response to intra-abdominal polytetrafluoroethylene mesh and composite prosthetic mesh. J Surg Res 2005;123(2):227–234.
Kemppainen E, Kiviluoto T. Fatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia. Surg Endosc 2000;14(6):593.
Hergueta-Delgado P, Marin-Moreno M, Morales-Conde S, et al. Transmural migration of a prosthetic mesh after surgery of a paraesophageal hiatal hernia. Gastrointest Endosc 2006;64(1):120; discussion 121.
Carlson MA, Condon RE, Ludwig KA, Schulte WJ. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 1998;187(3):227–230.
Edelman DS. Laparoscopic paraesophageal hernia repair with mesh. Surg Laparosc Endosc 1995;5(1):32–37.
van der Peet DL, Klinkenberg-Knol EC, Alonso Poza A, et al. Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment. Surg Endosc 2000;14(11):1015–1018.
Granderath FA, Schweiger UM, Kamolz T, et al. 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(1):40–48.
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):649–652.
Novitsky YW, Harrell AG, Cristiano JA, et al. Comparative evaluation of adhesion formation, strength of ingrowth, and textile properties of prosthetic meshes after long-term intra-abdominal implantation in a rabbit. J Surg Res 2007;140(1):6–11.
Benjamin SB, Kerr R, Cohen D, et al. Complications of the Angelchik antireflux prosthesis. Ann Intern Med 1984;100(4):570–575.
Lilly MP, Slafsky SF, Thompson WR. Intraluminal erosion and migration of the Angelchik antireflux prosthesis. Arch Surg 1984;119(7):849–853.
Kauten JR, Mansour KA. Complications of the Angelchik prosthesis in the management of gastroesophageal reflux. Am Surg 1986;52(4):208–213.
Purkiss SF, Argano VA, Kuo J, Lewis CT. Oesophageal erosion of an Angelchik prosthesis: surgical management using fundoplication. Eur J Cardiothorac Surg 1992;6(9):517–518.
Schauer PR, Ikramuddin S, McLaughlin RH, et al. Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg 1998;176(6):659–665.
Gajbhiye R, Quraishi AH, Mahajan P, Warhadpande M. Dysphagia due to transmural migration of polypropylene mesh into esophagus. Indian J Gastroenterol 2005;24(5):226–227.
Granderath FA, Kamolz T, Schweiger UM, Pointner R. Impact of laparoscopic Nissen fundoplication with prosthetic hiatal closure on esophageal body motility: results of a prospective randomized trial. Arch Surg 2006;141(7):625–632.
Varga G, Cseke L, Kalmar K, Horvath OP. Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias. Surg Endosc 2004;18(7):1051–1053.
Oelschlager BK, Barreca M, Chang L, Pellegrini CA. The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique. Am J Surg 2003;186(1):4–8.
Oelschlager BK, Pellegrini CA, Hunter J, et al. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 2006;244(4):481–490.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tatum, R.P., Shalhub, S., Oelschlager, B.K. et al. Complications of PTFE Mesh at the Diaphragmatic Hiatus. J Gastrointest Surg 12, 953–957 (2008). https://doi.org/10.1007/s11605-007-0316-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-007-0316-7