BACKGROUND: Mesh hiatoplasty is a widely debated topic among foregut surgeons. While short-term outcomes tout decreased recurrence rates, an increase in mesh-related complications has been reported. The aim of this study is to present a single-center experience with reoperative intervention in patients with previous mesh at the hiatus. METHODS: After institutional review board approval, a prospectively maintained database was retrospectively queried to identify patients who underwent reoperative intervention between 2003 and spring of 2013 and had mesh placed at a previous hiatal hernia procedure. Patient charts were reviewed and data variables collected. RESULTS: Twenty-six patients (mean age of 56.7 ± 18.3; 19 females) who underwent 27 procedures met the inclusion criteria. Synthetic mesh was placed in 15 (56 %) procedures, while the remaining 12 had biologic mesh. The mean interval between reoperative intervention and previous surgery was 33 months. Dysphagia (56 %) was the most common presentation, while three patients had mesh erosion. Recurrent hiatus hernia (2 to 7 cm) was noted in 19 (70 %) patients. Eight patients (30 %) underwent redo fundoplication, six patients (22 %) were converted to Roux-en-Y gastrojejunostomy, two patients (7.4 %) underwent distal esophagectomy with esophagojejunostomy, five patients (19 %) had subtotal esophagectomy with gastric pull-up, and one patient underwent substernal gastric pull-up for esophageal bypass with interval esophagectomy. The mean operative time was 252 ± 71.7 min, and the median blood loss was 150 ml (range, 50-1,650 ml). There was no postoperative mortality. CONCLUSION: Reoperative intervention in patients with mesh at the hiatus is associated with a high need for esophageal resection. More than two thirds of the patients also had a recurrent hiatal hernia.
BACKGROUND: Mesh hiatoplasty is a widely debated topic among foregut surgeons. While short-term outcomes tout decreased recurrence rates, an increase in mesh-related complications has been reported. The aim of this study is to present a single-center experience with reoperative intervention in patients with previous mesh at the hiatus. METHODS: After institutional review board approval, a prospectively maintained database was retrospectively queried to identify patients who underwent reoperative intervention between 2003 and spring of 2013 and had mesh placed at a previous hiatal hernia procedure. Patient charts were reviewed and data variables collected. RESULTS: Twenty-six patients (mean age of 56.7 ± 18.3; 19 females) who underwent 27 procedures met the inclusion criteria. Synthetic mesh was placed in 15 (56 %) procedures, while the remaining 12 had biologic mesh. The mean interval between reoperative intervention and previous surgery was 33 months. Dysphagia (56 %) was the most common presentation, while three patients had mesh erosion. Recurrent hiatus hernia (2 to 7 cm) was noted in 19 (70 %) patients. Eight patients (30 %) underwent redo fundoplication, six patients (22 %) were converted to Roux-en-Y gastrojejunostomy, two patients (7.4 %) underwent distal esophagectomy with esophagojejunostomy, five patients (19 %) had subtotal esophagectomy with gastric pull-up, and one patient underwent substernal gastric pull-up for esophageal bypass with interval esophagectomy. The mean operative time was 252 ± 71.7 min, and the median blood loss was 150 ml (range, 50-1,650 ml). There was no postoperative mortality. CONCLUSION: Reoperative intervention in patients with mesh at the hiatus is associated with a high need for esophageal resection. More than two thirds of the patients also had a recurrent hiatal hernia.
Authors: Michael Parker; Steven P Bowers; Jillian M Bray; Adam S Harris; Erol V Belli; Jason M Pfluke; Susanne Preissler; Horacio J Asbun; C Daniel Smith Journal: Surg Endosc Date: 2010-05-13 Impact factor: 4.584
Authors: Rudolf J Stadlhuber; Amr El Sherif; Sumeet K Mittal; Robert J Fitzgibbons; L Michael Brunt; John G Hunter; Tom R Demeester; Lee L Swanstrom; C Daniel Smith; Charles J Filipi Journal: Surg Endosc Date: 2008-12-06 Impact factor: 4.584
Authors: Stavros A Antoniou; Beat P Müller-Stich; George A Antoniou; Gernot Köhler; Ruzica-Rosalia Luketina; Oliver O Koch; Rudolph Pointner; Frank-Alexander Granderath Journal: Langenbecks Arch Surg Date: 2015-06-07 Impact factor: 3.445
Authors: H Reza Zahiri; Adam S Weltz; Udai S Sibia; Neethi Paranji; Steven D Leydorf; George T Fantry; Adrian E Park Journal: Surg Endosc Date: 2017-05-10 Impact factor: 4.584