Hiatal Repair Using Non-absorbable Mesh: Short-Term Outcome Analysis of 393 Consecutive Cases with a Focus on Prosthetic-Specific Complications

Abstract

AbstractThe use of prosthetic mesh to augment suture repair of large paraoesophageal hernias is widespread but controversial. Our aim was to identify the risk of mesh-specific complications from a large series of consecutive patients undergoing hiatal hernia repair augmented with a lightweight polypropylene mesh (TiMesh) over a 12-year period. A case series review of patients who have had prosthesis-reinforced hiatal repair with TiMesh between February 2005 and October 2017. Pre-operative, intra-operative, and post-operative data were collected for all patients undergoing hiatal repair. In total, 393 patients had TiMesh augmented hiatal repair between February 2005 and October 2017. There were no intraoperative mesh-specific complications. Mesh was explanted in one patient (1/393, 0.25%) who underwent emergency paraoesophageal hernia repair complicated by sepsis. Asymptomatic mesh erosion was found in two patients (2/393, 0.51%) at endoscopy 3 and 9 years following surgery, respectively. No cases of oesophageal or hiatal strictures were identified. From our large series, albeit without routine endoscopic and radiological follow-up, we demonstrate acceptably low rates of mesh-related complications. We identified two cases of asymptomatic erosion during 393 TiMesh repairs, and the rate of mesh-specific complications in this patient series is low. This unit will continue to perform selective TiMesh hiatal repair in cases where a suture repair only is felt to be inadequate at the time of surgery. For the purposes of patient consent and ongoing discussion, we report the risk of mesh erosion and mesh explantation to be 0.51% and 0.25%, respectively.