Biologic Mesh for Hiatal Hernias Appears Safe

Perioperative data were reviewed, and a questionnaire was administered, designed to identify symptoms of gastroesophageal reflux disease (GERD), other symptoms such as dysphagia, and all other operative or endoscopic interventions that occurred after mesh implantation. In addition, postoperative radiologic and endoscopic studies were reviewed to assess signs of complications related to use of mesh.

The researchers were able to contact 73 of the patients, at median follow-up of 45 months. No mesh-related complications were found. The frequency and severity of heartburn, regurgitation, and dysphagia improved significantly compared with preoperative values, and 89% of the patients reported good to excellent results in terms of overall satisfaction. Overall, the rate of dysphagia in the study was 2%, but no case seemed to be directly related to the mesh. No erosions, strictures, or other complications directly related to use of mesh were found. Only one patient required reoperation due to hiatal hernia recurrence with GERD symptoms. The study was published in the May 2012 issue of Surgical Endoscopy.

“Given the potential benefits of biologic mesh, we believe that surgeons who pay careful attention to its placement should feel reassured in the safety of using these meshes during hiatal hernia repair,” concluded lead author Eelco Wassenaar, MD, and colleagues of the department of surgery.

Dr. Wassenaar added that the surgical team used three key strategies that may reduce the risk for complications. The first was the use of a U-shaped, rather than a keyhole configuration, which leaves an open area in the anterior aspect of the esophagus. They also recommended covering the hiatus posterior to the esophagus, taking care to avoid pulling the mesh anteriorly and lifting the esophagus posteriorly to avoid narrowing of the esophagus. A third suggestion was to leave a small space between the edge of the mesh and the esophageal wall to avoid excessive contact of the mesh with the esophagus, which could lead to fibrosis and scarring, and potentially esophageal stricture.

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