Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate11No competing interests declared.

Abstract Background Many studies have shown that the importance of using mesh for paraesophageal hernia repair (PEHR) is to prevent recurrence. Unfortunately, it is associated with high risk of complications such as esophageal or gastric erosion. The aim of this study is to report the results of 38 patients who underwent laparoscopic PEHR with the use of a BioSynthetic mesh (GoreÒ Bio AÒ tissue Reinforcement.USA). Methods Observational, retrospective, single-center cohort study. We analysed retrospectively 38 consecutive patients with diagnosis of symptomatic Hiatal Hernia (HH) treated laparoscopically with an absorbable BioSynthetic mesh, between 2011–2017. The classic radiologic classification was used to classify the HH before surgery. This classification consists in four types/stages (I-IV). I: Sliding HH, II: Paraesophageal HH, III: Mixed form and IV: Intrathoracic stomach—upside-down hernia. All patients with Type III—IV hiatal hernia who underwent laparoscopic PEHR using an absorbable BioSynthetic mesh were included. We evaluated the results after PEHR with a symptoms questionnaire using a score 0–4 (Likert scale) and with an esophagogram and an esophagogastroduodenoscopy (EGD) analyzing the surgical success. Success was considered with symptomatic score improvement and/or absence of any symptomatic HH at the esophagogram and/or EGD. Results 38 patients: 7 males and 31 women. Median age: 66 (range 40–71). 12/38 (31,6%) patients had a type III HH and 26/38 (68,4%) a type IV. All these patients had been treated with a laparoscopic PEHR, using an absorbable BioSynthetic mesh as a reinforcement of the crura and Nissen fundoplication. The median follow-up was 12 months. 16/38 (42%) had a follow-up > 24 months. Success was evident in 95% of the patients. We observed 2 recurrences, one with a symptomatic type I HH and the other with an early type III HH recurrence. Conclusion The use of an absorbable synthetic mesh as a reinforcement of the crura in the treatment of the PEH has encouraging good results in the mild term follow up, with an extremely low incidence of complications. Disclosure All authors have declared no conflicts of interest.

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Assessment of short-term outcome with TiO2 mesh in laparoscopic repair of large paraesophageal hiatal hernias

BMC Surgery ◽

10.1186/s12893-019-0607-4 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Islam Khaled ◽

Pablo Priego ◽

Mohammed Faisal ◽

Marta Cuadrado ◽

Francisca García-Moreno ◽

...

Keyword(s):

Hiatal Hernia ◽

Laparoscopic Repair ◽

Postoperative Recurrence ◽

University Hospital ◽

Suture Repair ◽

Short Term ◽

Recurrence Rates ◽

Term Outcome ◽

Clinical Recurrence

Abstract Background Laparoscopic large para-oesophageal hiatal hernia (LPHH) repair using mesh reinforcement significantly reduces postoperative recurrence rates compared to conventional suture repair, especially within short follow-up times. However, the ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. The aim of this study was to survey our short-term results of LPHH management with a biosynthetic monofilament polypropylene mesh coated with titanium dioxide to enhance biocompatibility (TiO2Mesh™). Methods A retrospective study was performed at Ramon y Cajal University Hospital, Spain from December 2014 to October 2018. Data were collected on 27 consecutive patients with extensive hiatal hernia defects greater than 5 cm for which a laparoscopic repair was performed by primary suture and additional reinforcement with a TiO2Mesh™. Study outcomes were investigated, including clinical and radiological recurrences, dysphagia and mesh-related drawbacks. Results Twenty-seven patients were included in our analysis; 10 patients were male, and 17 were female. The mean age was 73 years (range, 63–79 years). All operations were performed laparoscopically. The median postoperative hospital stay was 3 days. After a mean follow-up of 18 months (range, 8-29 months), only 3 patients developed clinical recurrence of reflux symptoms (11%), and 2 had radiological recurrences (7%). No mesh-related complications occurred. Conclusions TiO2Mesh™ was found to be safe for laparoscopic repair of LPHH with a fairly low recurrence rate in this short-term study. Long-term studies conducted over a period of years with large sample sizes will be essential for confirming whether this mesh is suitable as a standard method of care with few drawbacks.

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