Long-Term Results of Giant Hiatal Hernia Mesh Repair and Antireflux Laparoscopic Surgery for Gastroesophageal Reflux Disease

Abstract

The application of mesh-reinforced hiatal closure has resulted in a significant reduction in recurrence rates. The most debated issue is the risk of complications related to the use of the prosthesis, which are thought to be the cause of higher dysphagia. From January 2004 to December 2007, 198 consecutive patients underwent laparoscopic fundoplication for gastroesophageal reflux disease (GERD) with or without hiatal hernia. Fifty patients (25.3%) presented a giant hiatal hernia, defined as a hiatal defect over 5 cm. These 50 patients underwent primary simple suture of the crura and additional reinforcement with a Crurasoft mesh (Bard). Hiatal hernia or GERD symptoms recurrence, dysphagia, and mesh-related complications were investigated. Of the 50 patients undergoing mesh repair, there were 32 women and 18 men with a mean age of 63.2 years. Conversion rate was 2%. Intraoperative complications rate was 6%, all of them laparoscopically managed. Postoperative complications occurred in 1 patient (2%). Mortality rate was 2%. Median postoperative stay was 3 days. Median follow-up was 62 months. Two percent of the patients presented wrap migration, and 4% presented dysphagia. Six percent of cases presented recurrence of GERD manifestations. There have been no complications related to the use of the mesh. Laparoscopic antireflux surgery with a prosthetic mesh in cases of giant hiatal hernia is an effective and safe procedure, reducing the rate of postoperative hernia recurrence during long-term follow-up. The incidence of mesh-related complications is very low.