Abstract
BackgroundLaparoscopic 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™).MethodsA 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.ResultsTwenty-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.ConclusionsTiO2Mesh™ 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.
Highlights
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
The aim of the current study is to present the short-term outcomes for patients who have undergone laparoscopic hiatal hernia repair with a synthetic monofilament polypropylene mesh with adherent titanium dioxide surface coating (TiO2MeshTM) that was synthesized by a German company named BioCer Entwicklungs-GmbH [large pored mesh structure (2,8 mm) and 47 g/m2], which differs from the lightweight TiMesh by the presence of a biocompatible coating, blue orientation strips and the hydrophilic implant surface that supports the intraoperative handling and placement of TiO2MeshTM
Nineteen cases were primary LPHH (70%), five cases were associated with gastric volvulus (18%), and 8 cases were large recurrent hiatal hernias (30%)
Summary
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. The ideal strategy for repairing LPHH remains disputable because no clear guidelines are given regarding indications, mesh type, shape or position. Large para-oesophageal hiatal hernia (LPHH) repair remains a controversial and challenging intervention for most practising surgeons [1, 2]. The standard method of repairing LPHH is still debatable, because short-term follow-up revealed that mesh-reinforced repair critically reduces the recurrence rate compared to conventional repair with sutures [4,5,6,7,8], no clear guidelines are given regarding indications, mesh type, shape and position [9, 10]. The short- and long-term results of these studies were not as satisfactory as previously imagined [23]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
