Hiatal Mesh Repair.. Marco Patti

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Surg Laparosc Endosc Percutan Tech. 2011 Apr;21(2):61-6.

Hiatal mesh repair--current status.

Herbella FA, Patti MG, Del Grande JC.

Most surgeons believe that cruroplasty (hiatoplasty) is an essential part of

antireflux operations. One of the main causes of failure after antireflux

operation is gastric (wrap) herniation through the hiatus that may be attributed

to breakdown of the hiatal closure or a faulty repair. Surgeons are at present

faced with the dilemma of choosing between a risk of recurrence and the fear of

complications of prosthetic hiatal reinforcement. We reviewed the literature to

evaluate the current status of hiatal mesh repair (HMR). Indication, technique,

complications, and results are shown. Available data show a small number of

mesh-related complications compared with the number of patients submitted to the

procedure, and better results of HMR compared with simple hiatal closure. We

support the use of HMR when performed by skilled foregut surgeons, as

complications described occurred more frequently in the earliest cases of the

series. In addition, HMR should be

probably used selectively. However, studies to identify the patients at risk of

hernia recurrence or mesh-related complications are still elusive. The ideal

type of mesh and the ideal technique for mesh implantation are yet to be

established.