Abstract
Background
Paraoesophageal hernias (PEH) have a high recurrence rate, prompting surgeons to consider the use of mesh reinforcement of the hiatus. The risks and benefits of mesh augmentation in PEH repair are debated. Mesh-related complications including migration and erosion are considered in this publication.
Design
A systematic literature review of articles published between 1970 and 2019 in Medline, OVID, Embase, and Springer database was conducted, identifying case reports, case series and observational studies of PEH repair reporting mesh-related complications.
Results
Thirty-five case reports/series of 74 patients and 20 observational studies reporting 75 of 4200 patients with mesh complications have been included. The incidence of mesh-related erosions in this study is 0.035%. PTFE, ePTFE, composite and synthetic meshes were frequently associated with mesh erosion requiring intervention. Complete erosions are often managed endoscopically while partial erosions may require surgery and resection of the oesophagus and/or stomach.
Conclusions
Mesh-related complication is rare with dysphagia a common presenting feature. Mesh erosion is associated with synthetic mesh more frequently in the reported literature. A mesh registry with long-term longitudinal data would help in understanding the true incidence of mesh-related complications.
Similar content being viewed by others
References
Watson DI, Thompson S, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG (2015) Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus non-absorbable mesh: a randomized controlled trial. Ann Surg 261(2):282–289
Carlson MA, Richards CG, Frantzides CT (1999) Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy. Dig Surg 16(5):407–410
Frantzides CT et al (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137(6):649–652
Granderath FA et al (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140(1):40–48
Oelschlager BK et al (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213(4):461–468
Oelschlager BK et al (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244(4):481–490
Watson DI et al (2019) Five year follow-up of a randomized controlled trial of laparoscopic repair of very large hiatus hernia with sutures versus absorbable versus nonabsorbable mesh. Ann Surg. https://doi.org/10.1097/SLA.0000000000003734
Oor JE et al (2018) Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh. Surg Endosc 32(11):4579–4589
Schlottmann F, Strassle PD, Patti MG (2017) Laparoscopic paraesophageal hernia repair: utilization rates of mesh in the USA and short-term outcome analysis. J Gastrointest Surg 21(10):1571–1576
Frantzides CT et al (2010) Hiatal hernia repair with mesh: a survey of SAGES members. Surg Endosc 24(5):1017–1024
Memon MA et al (2016) Suture cruroplasty versus prosthetic hiatal herniorrhaphy for large hiatal hernia: a meta-analysis and systematic review of randomized controlled trials. Ann Surg 263(2):258–266
Tam V, Winger DG, Nason KS (2016) A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg 211(1):226–238
Antoniou SA et al (2015) Laparoscopic augmentation of the diaphragmatic hiatus with biologic mesh versus suture repair: a systematic review and meta-analysis. Langenbecks Arch Surg 400(5):577–583
Furnee E, Hazebroek E (2013) Mesh in laparoscopic large hiatal hernia repair: a systematic review of the literature. Surg Endosc 27(11):3998–4008
Pfluke JM et al (2012) Use of mesh for hiatal hernia repair: a survey of SAGES members. Surg Endosc 26(7):1843–1848
Huddy JR et al (2016) Laparoscopic repair of hiatus hernia: does mesh type influence outcome? A meta-analysis and European survey study. Surg Endosc 30(12):5209–5221
Zhang C et al (2017) Systematic review and meta-analysis of laparoscopic mesh versus suture repair of hiatus hernia: objective and subjective outcomes. Surg Endosc 31(12):4913–4922
Granderath FA et al (2006) Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc 20(3):367–379
Schneider R, Herrington JL Jr, Granda AM (1979) Marlex mesh in repair of a diaphragmatic defect later eroding into the distal esophagus and stomach. Am Surg 45(5):337–339
Arendt T et al (2000) Dysphagia due to transmural migration of surgical material into the esophagus nine years after Nissen fundoplication. Gastrointest Endosc 51(5):607–610
Baladas HG et al (2000) Esophagogastric fistula secondary to teflon pledget: a rare complication following laparoscopic fundoplication. Dis Esophagus 13(1):72–74
Coluccio G et al (2000) Dislocation into the cardial lumen of a PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia, a case report. Minerva Chir 55(5):341–345
Gajbhiye R et al (2005) Dysphagia due to transmural migration of polypropylene mesh into esophagus. Indian J Gastroenterol 24(5):226–227
Hergueta-Delgado P et al (2006) Transmural migration of a prosthetic mesh after surgery of a paraesophageal hiatal hernia. Gastrointest Endosc 64(1):120 discussion 121
Bonavina L et al (2007) Pseudoachalasia occurring after laparoscopic Nissen fundoplication and crural mesh repair. Langenbecks Arch Surg 392(5):653–656
Dutta S (2007) Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery. J Pediatr Surg 42(1):252–256
Griffith PS et al (2008) Rejection of goretex mesh used in prosthetic cruroplasty: a case series. Int J Surg 6(2):106–109
Rumstadt B et al (2008) Gastric mesh erosion after hiatoplasty for recurrent paraesophageal hernia. Endoscopy 40(Suppl 2):E70
Tatum RP et al (2008) Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg 12(5):953–957
Hazebroek EJ, Leibman S, Smith GS (2009) Erosion of a composite PTFE/ePTFE mesh after hiatal hernia repair. Surg Laparosc Endosc Percutan Tech 19(2):175–177
Kepenekci I, Turkcapar AG (2009) Mesh erosion as a complication of laparoscopic fundoplication with prosthetic hiatal closure: report of a case. Surg Laparosc Endosc Percutan Tech 19(2):e51–e54
Stadlhuber RJ et al (2009) Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23(6):1219–1226
Fenton-Lee D, Tsang C (2010) A series of complications after paraesophageal hernia repair with the used of Timesh: a case report. Surg Laparosc Endosc Percutan Tech 20(3):e95–e96
Arroyo Q et al (2011) Dysphagia caused by migrated mesh after paraesophageal hernia repair. Endoscopy 43(Suppl 2):E257–E258
Carpelan-Holmstrom M et al (2011) Late mesh migration through the stomach wall after laparoscopic refundoplication using a dual-sided PTFE/ePTFE mesh. Hernia 15(2):217–220
De Moor V et al (2012) Complications of mesh repair in hiatal surgery: about 3 cases and review of the literature. Surg Laparosc Endosc Percutan Tech 22(4):e222–e225
Porziella V et al (2012) Complete transmural gastric migration of PTFE mesh after surgery for a recurrent hiatal hernia. Eur Rev Med Pharmacol Sci 16(Suppl 4):42–43
Acin-Gandara D et al (2014) Transmural gastric migration of dual-sided PTFE/ePTFEE mesh after laparoscopic surgery for a recurrent hiatal hernia with dysphagia: case report. Chirurgia (Bucur) 109(4):538–541
Perez Lara FJ et al (2014) Mesh extrusion into the esophageal lumen after surgery for a giant hiatal hernia. Am Surg 80(12):E364–E366
Cole W, Zagorski S (2015) Intramural gastric abscess following laparoscopic paraesophageal hernia repair. Endoscopy 47(Suppl 1):E227–E228
Bognar L et al (2015) In process citation. Magy Seb 68(4):176–180
Kakarala K, Edriss H, Nugent K (2015) Gastropericardial fistula as a delayed complication of a Nissen fundoplication. Proc (Bayl Univ Med Cent) 28(4):478–481
Liang WT et al (2015) Mesh-related complications after hiatal hernia repair: two case reports. Gastroenterol Nurs 38(3):226–229
Bathgate G et al (2016) An unusual cause for halitosis. BMJ Case Rep. https://doi.org/10.1136/bcr-2015-21327
Leitao C et al (2016) Late transmural mesh migration into the esophagus after Nissen fundoplication. Endoscopy 48(Suppl 1):E166–E167
van Peters AMT, Diederik AL, Tjan DH (2016) Colopleural fistula after hiatal hernia repair. BMJ Case Rep. https://doi.org/10.1136/bcr-2016-216814
Virgilio E, Mercantini P, Cavallini M (2016) Partial transmural gastroesophageal migration of polypropylene mesh after surgery for a recurrent hiatal hernia. Eur Rev Med Pharmacol Sci 20(17):3515–3516
Berg BCR, Panzer K, Powers B, Gupta S, Patel T (2017) Complete gastric transmural migration of a prosthetic hiatal hernia. Appl Radiol 47(1):40–42
Yatabe K et al (2017) Late esophageal wall injury after mesh repair for large esophageal hiatal hernia: a case report. Surg Case Rep 3(1):125
Borraez-Segura B et al (2019) Mesh migration after hiatal hernia repair. Indian J Gastroenterol 38(5):462–464
Oguri Y et al (2018) Case of complete mesh migration into the stomach after mesh hiatoplasty for a hiatal hernia. Asian J Endosc Surg 11(4):395–398
Rancourt M, Pare A, Comeau E (2019) Intraoesophageal migration of Teflon pledgets used for hiatal hernia repair: a serious adverse event. BMJ Case Rep 12(4):224383
Sanchez-Pernaute A et al (2019) Intraluminal mesh erosion after prosthetic hiatoplasty: incidence, management, and outcomes. Dis Esophagus 32(7):doy131
Trus TL et al (1997) Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1(3):221–227 discussion 228
van der Peet DL et al (2000) Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment. Surg Endosc 14(11):1015–1018
Dally E, Falk GL (2004) Teflon pledget reinforced fundoplication causes symptomatic gastric and esophageal lumenal penetration. Am J Surg 187(2):226–229
Zilberstein BER, Pajecki D, Granja C, Brito ACG (2005) Laparoscopic mesh repair antireflux surgery for treatment of large hiatal hernia. Dis Esophagus 18(3):166–169
Lee E et al (2007) Evaluation of acellular human dermis reinforcement of the crural closure in patients with difficult hiatal hernias. Surg Endosc 21(4):641–645
Boushey RP et al (2008) Laparoscopic repair of paraesophageal hernias: a Canadian experience. Can J Surg 51(5):355–360
Soricelli E et al (2009) Long-term results of hiatal hernia mesh repair and antireflux laparoscopic surgery. Surg Endosc 23(11):2499–2504
Zugel N et al (2009) Severe complication of laparoscopic mesh hiatoplasty for paraesophageal hernia. Surg Endosc 23(11):2563–2567
Gouvas N et al (2011) Simple suture or prosthesis hiatal closure in laparoscopic repair of paraesophageal hernia: a retrospective cohort study. Dis Esophagus 24(2):69–78
Bell RC, Fearon J, Freeman KD (2013) Allograft dermal matrix hiatoplasty during laparoscopic primary fundoplication, paraesophageal hernia repair, and reoperation for failed hiatal hernia repair. Surg Endosc 27(6):1997–2004
Chilintseva N et al (2012) Laparoscopic prosthetic hiatal reinforcement for large hiatal hernia repair. J Visc Surg 149(3):e215–e220
Nandipati K et al (2013) Reoperative intervention in patients with mesh at the hiatus is associated with high incidence of esophageal resection–a single-center experience. J Gastrointest Surg 17(12):2039–2044
Ortiz I et al (2009) Quality of life and long-term results of reinterventions performed by laparoscopy after oesophageal hiatus surgery. Cir Esp 86(2):72–78
Priego P et al (2017) Long-term results and complications related to Crurasoft((R)) mesh repair for paraesophageal hiatal hernias. Hernia 21(2):291–298
Targarona EM et al (2013) Long-term outcome and quality of life after laparoscopic treatment of large paraesophageal hernia. World J Surg 37(8):1878–1882
Campos V et al (2020) Laparoscopic treatment of giant hiatal hernia with or without mesh reinforcement: a systematic review and meta-analysis. Int J Surg 77:97–104
Memon MA et al (2019) Suture cruroplasty versus mesh hiatal herniorrhaphy for large hiatal hernias (HHs): an updated meta-analysis and systematic review of randomized controlled trials. Surg Laparosc Endosc Percutan Tech 29(4):221–232
Sathasivam R et al (2019) 'Mesh hiatal hernioplasty' versus 'suture cruroplasty' in laparoscopic para-oesophageal hernia surgery; a systematic review and meta-analysis. Asian J Surg 42(1):53–60
Senft J et al (2014) Influence of weight and structure on biological behavior of polypropylene mesh prostheses placed at the esophageal hiatus. J Laparoendosc Adv Surg Tech A 24(6):383–390
Dallemagne B et al (2011) Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg 253(2):291–296
Kockerling F, Schug-Pass C, Bittner R (2018) A word of caution: never use tacks for mesh fixation to the diaphragm! Surg Endosc 32(7):3295–3302
Jansen M et al (2007) Mesh migration into the esophageal wall after mesh hiatoplasty: comparison of two alloplastic materials. Surg Endosc 21(12):2298–2303
Tanase M et al (2012) The use of allografts in the surgical treatment of enlarged hiatal hernias. Chirurgia (Bucur) 107(2):195–198
Muller-Stich BP et al (2009) Is a circular polypropylene mesh appropriate for application at the esophageal hiatus? Results from an experimental study in a porcine model. Surg Endosc 23(6):1372–1378
Smith GS et al (2008) Evaluation of DualMesh for repair of large hiatus hernia in a porcine model. Surg Endosc 22(7):1625–1631
Antonakis F, Kockerling F, Kallinowski F (2016) Functional results after repair of large hiatal hernia by use of a biologic mesh. Front Surg 3:16
Travers HC et al (2016) Diaphragmatic crural augmentation utilising cross-linked porcine dermal collagen biologic mesh (Permacol) in the repair of large and complex para-oesophageal herniation: a retrospective cohort study. Hernia 20(2):311–320
Rubin M (2017) When does harking hurt? Identifying when different types of undisclosed post hoc hypothesizing harm scientific progress. Rev General Psychol 21(4):308–320
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Calista Spiro, Natalie Quarmby and Siva Gananadha have no conflicts of interest or financial ties to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Spiro, C., Quarmby, N. & Gananadha, S. Mesh-related complications in paraoesophageal repair: a systematic review. Surg Endosc 34, 4257–4280 (2020). https://doi.org/10.1007/s00464-020-07723-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-020-07723-0