Abstract | BACKGROUND: The use of mesh for laparoscopic repair of large hiatal hernias may reduce recurrence rates in comparison with primary suture repair. However, there is a potential risk of mesh-related oesophageal complications due to prosthesis erosion. The aim of this study was to evaluate a lightweight polypropylene mesh (TiMesh) repair of hiatal hernias with particular reference to intraluminal erosion. METHODS: Data were collected prospectively on 18 consecutive patients undergoing elective laparoscopic repair of a large hiatal hernia with the use of TiMesh between November 2004 and December 2005. Quality of life and symptom analysis was performed using QOLRAD questionnaires preoperatively and postoperatively after 6 weeks, 6 months, 1 year and 2 years. Barium studies were performed preoperatively and 2 years postoperatively to assess hernia recurrence. After 2 years, oesophagogastric endoscopy was performed to assess signs of mesh-related complications. RESULTS: All operations were completed laparoscopically. There was no 30-day mortality and median hospital stay was 2.8 days (range 2-13 days). Complications occurred in two patients (11%), both of whom were treated without residual disability. Two years after hiatal hernia repair, there was significant improvement in quality-of-life scores (QOLRAD 5.79, p < 0.001). There was no difference between pre- and postoperative dysphagia scores. No signs of stricture formation or prosthetic erosion were identified during endoscopic follow-up. One patient had a small (2 cm) sliding hiatal hernia demonstrated by barium studies, which was asymptomatic. CONCLUSIONS: Laparoscopic reinforcement of primary hiatal closure with TiMesh leads to a durable repair in patients with large hiatal hernias. Endoscopic follow-up did not show any signs of mesh-related complications after prosthetic reinforcement of the crural repair. Our preliminary results suggest that it is safe to proceed with this lightweight polypropylene mesh for reinforcement of the hiatal repair.
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Authors | Eric J Hazebroek, Ada Ng, David H K Yong, Hayley Berry, Steven Leibman, Garett S Smith |
Journal | Surgical endoscopy
(Surg Endosc)
Vol. 22
Issue 11
Pg. 2428-32
(Nov 2008)
ISSN: 1432-2218 [Electronic] Germany |
PMID | 18626699
(Publication Type: Evaluation Study, Journal Article)
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Chemical References |
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Topics |
- Aged
- Aged, 80 and over
- Esophagoscopy
- Female
- Hernia, Hiatal
(diagnostic imaging, surgery)
- Humans
- Laparoscopy
- Length of Stay
(statistics & numerical data)
- Male
- Middle Aged
- Polypropylenes
- Postoperative Complications
- Prospective Studies
- Quality of Life
- Radiography
- Recurrence
- Surgical Mesh
- Surveys and Questionnaires
- Titanium
- Treatment Outcome
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