Mesh complications after prosthetic reinforcement of hiatal closure: A 28-case series

Rudolf J. Stadlhuber, Amr El Sherif, Sumeet K. Mittal, Robert J. Fitzgibbons, L. Michael Brunt, John Hunter, Tom R. DeMeester, Lee L. Swanstrom, C. Daniel Smith, Charles J. Filipi

Research output: Contribution to journalArticle

212 Citations (Scopus)

Abstract

Background: Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0-24%). However, mesh complications have been observed. Methods: We compiled two cases, and our senior author contacted other experienced esophageal surgeons who provided 26 additional cases with mesh-related complications. Care was taken to retrieve technical operative details concerning mesh size and shape and implantation technique used. Results: Twenty-six patients underwent laparoscopic and two patients open surgery for large hiatal hernia (n = 28). Twenty-five patients had a concomitant Nissen fundoplication, two a Toupet fundoplication, and one a Watson fundoplication. Mesh types placed were polypropylene (n = 8), polytetrafluoroethylene (PTFE) (n = 12), biological mesh (n = 7), and dual mesh (n = 1). Presenting symptoms associated with mesh complications were dysphagia (n = 22), heartburn (n = 10), chest pain (n = 14), fever (n = 1), epigastric pain (n = 2), and weight loss (n = 4). Main reoperative findings were intraluminal mesh erosion (n = 17), esophageal stenosis (n = 6), and dense fibrosis (n = 5). Six patients required esophagectomy, two patients had partial gastrectomy, and 1 patient had total gastrectomy. Five patients did not require surgery. In this group one patient had mesh removal by endoscopy. There was no immediate postoperative mortality, however one patient has severe gastroparesis and five patients are dependent on tube feeding. Two patients died 3 months postoperatively of unknown cause. There is no apparent relationship between mesh type and configuration with the complications encountered. Conclusion: Complications related to synthetic mesh placement at the esophageal hiatus are more common than previously reported. Multicenter prospective studies are needed to determine the best method and type of mesh for implantation.

Original languageEnglish (US)
Pages (from-to)1219-1226
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume23
Issue number6
DOIs
StatePublished - Jun 2009

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Fundoplication
Hiatal Hernia
Gastrectomy
Reinforcement (Psychology)
Gastroparesis
Recurrence
Esophageal Stenosis
Heartburn
Esophagectomy
Polypropylenes
Herniorrhaphy
Polytetrafluoroethylene
Enteral Nutrition
Deglutition Disorders
Chest Pain
Endoscopy
Multicenter Studies
Weight Loss
Leg
Fibrosis

Keywords

  • Esophageal perforation
  • Hiatal hernia
  • Mesh
  • Mesh erosion
  • Prosthetic hiatoplasty

ASJC Scopus subject areas

  • Surgery

Cite this

Stadlhuber, R. J., Sherif, A. E., Mittal, S. K., Fitzgibbons, R. J., Brunt, L. M., Hunter, J., ... Filipi, C. J. (2009). Mesh complications after prosthetic reinforcement of hiatal closure: A 28-case series. Surgical Endoscopy and Other Interventional Techniques, 23(6), 1219-1226. https://doi.org/10.1007/s00464-008-0205-5

Mesh complications after prosthetic reinforcement of hiatal closure : A 28-case series. / Stadlhuber, Rudolf J.; Sherif, Amr El; Mittal, Sumeet K.; Fitzgibbons, Robert J.; Brunt, L. Michael; Hunter, John; DeMeester, Tom R.; Swanstrom, Lee L.; Smith, C. Daniel; Filipi, Charles J.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 23, No. 6, 06.2009, p. 1219-1226.

Research output: Contribution to journalArticle

Stadlhuber, RJ, Sherif, AE, Mittal, SK, Fitzgibbons, RJ, Brunt, LM, Hunter, J, DeMeester, TR, Swanstrom, LL, Smith, CD & Filipi, CJ 2009, 'Mesh complications after prosthetic reinforcement of hiatal closure: A 28-case series', Surgical Endoscopy and Other Interventional Techniques, vol. 23, no. 6, pp. 1219-1226. https://doi.org/10.1007/s00464-008-0205-5
Stadlhuber, Rudolf J. ; Sherif, Amr El ; Mittal, Sumeet K. ; Fitzgibbons, Robert J. ; Brunt, L. Michael ; Hunter, John ; DeMeester, Tom R. ; Swanstrom, Lee L. ; Smith, C. Daniel ; Filipi, Charles J. / Mesh complications after prosthetic reinforcement of hiatal closure : A 28-case series. In: Surgical Endoscopy and Other Interventional Techniques. 2009 ; Vol. 23, No. 6. pp. 1219-1226.
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abstract = "Background: Primary laparoscopic hiatal hernia repair is associated with up to a 42{\%} recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0-24{\%}). However, mesh complications have been observed. Methods: We compiled two cases, and our senior author contacted other experienced esophageal surgeons who provided 26 additional cases with mesh-related complications. Care was taken to retrieve technical operative details concerning mesh size and shape and implantation technique used. Results: Twenty-six patients underwent laparoscopic and two patients open surgery for large hiatal hernia (n = 28). Twenty-five patients had a concomitant Nissen fundoplication, two a Toupet fundoplication, and one a Watson fundoplication. Mesh types placed were polypropylene (n = 8), polytetrafluoroethylene (PTFE) (n = 12), biological mesh (n = 7), and dual mesh (n = 1). Presenting symptoms associated with mesh complications were dysphagia (n = 22), heartburn (n = 10), chest pain (n = 14), fever (n = 1), epigastric pain (n = 2), and weight loss (n = 4). Main reoperative findings were intraluminal mesh erosion (n = 17), esophageal stenosis (n = 6), and dense fibrosis (n = 5). Six patients required esophagectomy, two patients had partial gastrectomy, and 1 patient had total gastrectomy. Five patients did not require surgery. In this group one patient had mesh removal by endoscopy. There was no immediate postoperative mortality, however one patient has severe gastroparesis and five patients are dependent on tube feeding. Two patients died 3 months postoperatively of unknown cause. There is no apparent relationship between mesh type and configuration with the complications encountered. Conclusion: Complications related to synthetic mesh placement at the esophageal hiatus are more common than previously reported. Multicenter prospective studies are needed to determine the best method and type of mesh for implantation.",
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AU - Fitzgibbons, Robert J.

AU - Brunt, L. Michael

AU - Hunter, John

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