Hiatal repair using non-absorbable mesh: Prosthesis-specific complications from a consecutive case series examining short-term outcomes

Abstract

Abstract Purpose: The 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. Methods: A retrospective cohort study of prospectively collected data for patients undergoing prosthesis reinforced hiatal repair with TiMesh between February 2005, and October 2017 were identified. Pre-operative, intra-operative and post-operative data were collected for all patients undergoing hiatal repair. Results: In total, 393 patients underwent 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 three and nine years following surgery, respectively. No cases of oesophageal or hiatal strictures were identified. Conclusion: 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.