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Aiolfi A, Sozzi A, Bonitta G, Bona D, Bonavina L. Foregut Erosion Related to Biomedical Implants: A Scoping Review. J Laparoendosc Adv Surg Tech A 2024; 34:691-709. [PMID: 39102627 DOI: 10.1089/lap.2024.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024] Open
Abstract
Introduction: Biomedical devices implanted transabdominally have gained popularity over the past 50 years in the treatment of gastroesophageal reflux disease, paraesophageal hiatal hernia, and morbid obesity. Device-related foregut erosions (FEs) represent a challenging event that demands special attention owing to the potential of severe postoperative complications and death. Purpose: The aim was to provide an overview of full-thickness foregut injury leading to erosion associated with four types of biomedical devices. Methods: The study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). PubMed, EMBASE, and Web of Science databases were queried until December 31, 2023. Eligible studies included all articles reporting data, management, and outcomes on device-related FE. Results: Overall, 132 articless were included for a total of 1292 patients suffering from device-related FE. Four different devices were included: the Angelchik antireflux prosthesis (AAP) (n = 25), nonabsorbable mesh for crural repair (n = 60), adjustable gastric banding (n = 1156), and magnetic sphincter augmentation device (n = 51). The elapsed time from device implant to erosion ranged from 1 to 480 months. Most commonly reported symptoms were dysphagia and epigastric pain, while acute presentation was reported rarely and mainly for gastric banding. The technique for device removal evolved from more invasive open approaches toward minimally invasive and endoscopic techniques. Esophagectomy and gastrectomy were mostly reported for nonabsorbable mesh FE. Overall mortality was .17%. Conclusions: Device-related FE is rare but may occur many years after AAP, nonabsorbable mesh, adjustable gastric banding, and magnetic sphincter augmentation implant. FE-related mortality is infrequent, however, increased postoperative morbidity and the need for esophagogastric resection were observed for nonabsorbable mesh-reinforced cruroplasty.
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Affiliation(s)
- Alberto Aiolfi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Andrea Sozzi
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Gianluca Bonitta
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Davide Bona
- Division of General Surgery, Department of Biomedical Science for Health, I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, University of Milan, Milano, Italy
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
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Mesh-related complications in paraoesophageal repair: a systematic review. Surg Endosc 2020; 34:4257-4280. [PMID: 32556700 DOI: 10.1007/s00464-020-07723-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/09/2020] [Indexed: 01/25/2023]
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.
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Braghetto I, Korn O, Rojas J, Valladares H, Figueroa M. Hiatal hernia repair: prevention of mesh erosion and migration into the esophagogastric junction. ACTA ACUST UNITED AC 2020; 33:e1489. [PMID: 32428134 PMCID: PMC7236328 DOI: 10.1590/0102-672020190001e1489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023]
Abstract
Background:
Erosion and migration into the esophagogastric lumen after laparoscopic
hiatal hernia repair with mesh placement has been published. Aim: To present surgical maneuvers that seek to diminish the risk of this
complication. Method: We suggest mobilizing the hernia sac from the mediastinum and taking it down
to the abdominal position with its blood supply intact in order to rotate it
behind and around the abdominal esophagus. The purpose is to cover the
on-lay mesh placed in “U” fashion to reinforce the crus suture. Results: We have performed laparoscopic hiatal hernia repair in 173 patients (total
group). Early postoperative complications were observed in 35 patients
(27.1%) and one patient died (0.7%) due to a massive lung thromboembolism.
One hundred twenty-nine patients were followed-up for a mean of 41+28months.
Mesh placement was performed in 79 of these patients. The remnant sac was
rotated behind the esophagus in order to cover the mesh surface. In this
group, late complications were observed in five patients (2.9%). We have not
observed mesh erosion or migration to the esophagogastric lumen. Conclusion: The proposed technique should be useful for preventing erosion and migration
into the esophagus.
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Affiliation(s)
- Italo Braghetto
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Owen Korn
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jorge Rojas
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Hector Valladares
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Manuel Figueroa
- Hospital Dr. José J. Aguirre, Faculty of Medicine, University of Chile, Santiago, Chile
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Quilici PJ, Tovar A, Li J, Herrera T. Laparoscopic anti-reflux procedures with hepatic shoulder technique in the surgical management of large hiatal hernias and paraesophageal hernias: a follow-up study. Surg Endosc 2019; 34:2460-2464. [PMID: 31363892 DOI: 10.1007/s00464-019-07040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Numerous techniques have been historically proposed in the management of gastroesophageal reflux and paraesophageal hernias (PEH). A follow-up study (Quilici et al. in Surg Endosc 23(11):2620-2623, 2009) to a novel laparoscopic approach introduced in 2009 and performed in 49 patients is presented. METHODS All procedures were performed via laparoscopy. Thirty-two patients underwent a Nissen Fundoplication, eleven a reduction of the PEH with a Nissen fundoplication, two without a fundoplication, and four with a Collis-Nissen fundoplication. In all patients, the left hepatic lobe was freed, repositioned, and anchored under and inferior to the gastroesophageal junction, propping the gastroesophageal junction anteriorly. This maneuver entirely covers and closes the diaphragmatic defect. RESULTS At the time of laparoscopy, several patients were found not to be suitable candidates for this procedure (morphology of the left hepatic lobe). Forty-nine procedures were completed. One patient was re-explored on POD 2 for a tight hiatus post-Collis fundoplication. Post-operatively, all other patients did well without notable, unusual complaints. The average length of stay was 2.2 days. Although not statistically significant, 43 patients had no recurrence of symptoms with the longest follow-up at 10 years, two patients were lost to follow-up, one patient had a recurrence of the PEH and three patients stated they were experiencing some form of gastroesophageal reflux requiring medical management. CONCLUSION In selected patients, patients with an "at-risk" crural closure during a laparoscopic anti-reflux procedure or PEH can safely be managed via a laparoscopic anti-reflux procedure with the hepatic shoulder technique. This technique has shown good early post-operative results and could be used as an alternative to a laparoscopic mesh-reinforced fundoplication in difficult crural closures or in the management of large paraesophageal hernias.
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Affiliation(s)
- Philippe J Quilici
- Minimally Invasive and Bariatric Surgical Services, Providence Saint Joseph Medical Center, PSJHS, Burbank, CA, USA.
| | - Alexander Tovar
- Minimally Invasive and Bariatric Surgical Services, Providence Saint Joseph Medical Center, PSJHS, Burbank, CA, USA
| | - Jung Li
- Minimally Invasive and Bariatric Surgical Services, Providence Saint Joseph Medical Center, PSJHS, Burbank, CA, USA
| | - Tiffany Herrera
- Minimally Invasive and Bariatric Surgical Services, Providence Saint Joseph Medical Center, PSJHS, Burbank, CA, USA
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Li J, Cheng T. Mesh erosion after hiatal hernia repair: the tip of the iceberg? Hernia 2019; 23:1243-1252. [DOI: 10.1007/s10029-019-02011-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
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De Moura EGH, Sallum RAA, Nasi A, Coronel M, De Moura DTH, De Moura ETH, Minata MK, Cury M, Falcão A, Cecconello I, Sakai P. Endoscopic polymer injection and endoluminal plication in treatment of gastroesophageal reflux disease: evaluation of long-term results. Endosc Int Open 2018; 6:E630-E636. [PMID: 29756023 PMCID: PMC5943693 DOI: 10.1055/a-0573-1194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/03/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Us of proton pump inhibitors (PPIs) has made endoscopic treatment of gastroesophageal reflux disease (GERD) more efficient, with reduction in morbidity and complications. However, some patients persist with symptoms despite medical treatment and some are not compliant with it or cannot afford it for financial reasons, and thus they require non-pharmacological therapeutic options such as surgical fundoplication. Surgery may be effective in the short term, but there is related morbidity and concern about its long-term efficacy. The possibility of minimally invasive endoluminal surgeries has resulted in interest in and development of newly endoscopic devices. Good short-term results with surgical fundoplication lack of studies of is with long follow-up justify our interest in this study. The aim of this study was to investigate the efficacy of endoscopic polymer injection and endoluminal full-thickness plication in the long-term control of GERD. PATIENTS AND METHODS Forty-seven patients with GERD who underwent an endoscopic procedure were followed up for 60 months and evaluated for total response (RT), partial response (RP) and no response (SR) to endoscopic treatment with reintroduction of PPIs. RESULTS Twenty-one patients received polymer injection (G0) and 26 endoluminal plication (G1). The number of patients with no response to endoscopic treatment with reintroduction of PPIs increased in time for both techniques (G0 P = 0.006; G1 P < 0.001). There was symptomatic improvement up to 12 months, with progressive loss of this trending up to 60 months in G0 and G1 ( P < 0.001). Health-related quality of life score (GERD-HRQL) demonstrated TR in G0 and G1 at 1, 3, 6 and 12 months. The 60-month analysis showed an increased number of patients with SR in both groups. The quality of life assessment (SF-36) showed benefit in G0 up to 3 months. G0 showed a higher rate of complications. There were no deaths. There was healing of esophagitis at 3 months in 45 % of patients in G0 and 40 % in G1. There was no improvement in manometric or pH findings. CONCLUSION Endoscopic therapies were ineffective in controlling GERD in the long term.
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Affiliation(s)
| | - Rubens A. A. Sallum
- Gastrointestinal Surgical Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ary Nasi
- Gastrointestinal Surgical Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Martin Coronel
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil,Corresponding author Martin Coronel Universidade de São Paulo Faculdade de MedicinaGastrointestinal EndoscopyAv. Dr Enéas de Carvalho Aguiar 225
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andar, bloco 3
Cerqueira Cezar ZIP Code 05403-010São Paulo, SP, Brazil+55-112-661-6467
| | - Diogo Turiani Hourneaux De Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Mauricio Kazuyoshi Minata
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Cury
- Gastrointestinal Surgical Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Angela Falcão
- Gastrointestinal Surgical Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ivan Cecconello
- Gastrointestinal Surgical Department, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Paulo Sakai
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
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Abstract
High rates of recurrence in hiatus hernia and antireflux surgery led to the introduction of different methods for diaphragm closure. Prosthetic diaphragm closure with meshes remains a controversial issue in the literature. Available data show lower recurrence rates after prosthetic diaphragm closure; however, there is no clear standard for the indications and technique. Despite the availability of a few prospective randomized trials, a clear recommendation regarding this issue cannot currently be given.
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Ilyashenko VV, Grubnyk VV, Grubnik VV. Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair. Surg Endosc 2018; 32:3592-3598. [DOI: 10.1007/s00464-018-6087-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 02/01/2018] [Indexed: 12/23/2022]
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Liang WT, Yan C, Wang ZG, Wu JM, Hu ZW, Zhan XL, Wang F, Ma SS, Chen MP. Early and Midterm Outcome After Laparoscopic Fundoplication and a Minimally Invasive Endoscopic Procedure in Patients with Gastroesophageal Reflux Disease: A Prospective Observational Study. J Laparoendosc Adv Surg Tech A 2016; 25:657-61. [PMID: 26258269 DOI: 10.1089/lap.2015.0188] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND AIMS Although the minimally invasive endoscopic Stretta procedure is being increasingly used as an alternative strategy to manage gastroesophageal reflux disease (GERD), the benefits of this procedure have to be further evaluated in clinical settings. This prospective observational study assessed the short-term and midterm outcomes associated with laparoscopic Toupet fundoplication (LTF) and the Stretta procedure. PATIENTS AND METHODS From January 2011 to January 2012, we allocated 80 patients to LTF and 85 to the Stretta procedure. Primary outcome measures, including symptom scores of heartburn, regurgitation, chest pain, belching, hiccup, cough, and asthma, as well as proton pump inhibitor (PPI) use, were analyzed at midterm follow-up (1-3 years). RESULTS Of the 165 patients, 125 patients following LTF (n=65) or the Stretta procedure (n=60) completed the designated 3-year follow-up and were included in the final analysis. At the end of the 3-year follow-up, the symptom scores were all significantly decreased compared with the corresponding values before the two procedures in both groups (P<.05). After LTF and the Stretta procedure, 47/65 (72.3%) and 41/60 (68.3%) patients, respectively, achieved complete PPI therapy independence (72.3% versus 68.3%, P=.627). Comparing with LTF, however, the Stretta procedure had less effect on improving typical symptoms of heartburn, regurgitation, and chest pain and reducing the rate of re-operation (11.8% versus 0%, P=.006). CONCLUSIONS LTF and the Stretta procedure were equally effective in controlling GERD symptoms and reducing PPI use. However, LTF can achieve more improvement on typical symptoms and has a lower rate of re-operation.
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Affiliation(s)
- Wei-Tao Liang
- 1 Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University , Beijing, China
| | - Chao Yan
- 1 Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University , Beijing, China
| | - Zhong-Gao Wang
- 1 Department of Vascular Surgery, Xuan Wu Hospital, Capital Medical University , Beijing, China
| | - Ji-Min Wu
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Zhi-Wei Hu
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Xiu-Lan Zhan
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Feng Wang
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Song-Song Ma
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
| | - Mei-Ping Chen
- 2 Department of Gastroesophageal Reflux Disease, Second Artillery General Hospital of Chinese People's Liberation Army , Beijing, China
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Long-term outcomes of cruroplasty reinforcement with composite versus biologic mesh for gastroesophageal reflux disease. Surg Endosc 2015; 30:2865-72. [DOI: 10.1007/s00464-015-4570-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/15/2015] [Indexed: 12/13/2022]
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Lara FJP, Fernández JD, Quecedo TG, Lafuente FC, Muñoz HO. Mesh Extrusion into the Esophageal Lumen after Surgery for a Giant Hiatal Hernia. Am Surg 2014. [DOI: 10.1177/000313481408001215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zilberstein B, Ferreira JA, Carvalho MHD, Bussons C, Silveira-Filho AS, Joaquim H, Ramos F. Dysphagia after hiatal hernia correction. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 27:228-9. [PMID: 25184780 PMCID: PMC4676379 DOI: 10.1590/s0102-67202014000300018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/22/2014] [Indexed: 11/21/2022]
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Linke GR, Gehrig T, Hogg LV, Göhl A, Kenngott H, Schäfer F, Fischer L, Gutt CN, Müller-Stich BP. Laparoscopic mesh-augmented hiatoplasty without fundoplication as a method to treat large hiatal hernias. Surg Today 2013; 44:820-6. [PMID: 23670038 PMCID: PMC3986894 DOI: 10.1007/s00595-013-0609-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 03/04/2013] [Indexed: 01/01/2023]
Abstract
Purpose Laparoscopic hiatal hernia repair with additional fundoplication is a commonly recommended standard surgical treatment for symptomatic large hiatal hernias with paraesophageal involvement (PEH). However, due to the risk of persistent side effects, this method remains controversial. Laparoscopic mesh-augmented hiatoplasty without fundoplication (LMAH), which combines hiatal repair and mesh reinforcement, might therefore be an alternative. Methods In this retrospective study of 55 (25 male, 30 female) consecutive PEH patients, the perioperative course and symptomatic outcomes were analyzed after a mean follow-up of 72 months. Results The mean DeMeester symptom score decreased from 5.1 to 1.8 (P < 0.001) and the gas bloating value decreased from 1.2 to 0.5 (P = 0.001). The dysphagia value was 0.7 before surgery and 0.6 (P = 0.379) after surgery. The majority of the patients were able to belch and vomit (96 and 92 %, respectively). Acid-suppressive therapy on a regular basis was discontinued in 68 % of patients. In 4 % of patients, reoperation was necessary due to recurrent or persistent reflux. A mesh-related stenosis that required endoscopic dilatation occurred in 2 % of patients. Conclusions LMAH is feasible, safe and provides an anti-reflux effect, even without fundoplication. As operation-related side effects seem to be rare, LMAH is a potential treatment option for large hiatal hernias with paraesophageal involvement.
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Affiliation(s)
- Georg R Linke
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Rectus abdominus fascial sheath usage for crural reinforcement during surgical management of GERD: preliminary report of a prospective randomized clinical trial. Surg Laparosc Endosc Percutan Tech 2012; 22:333-7. [PMID: 22874682 DOI: 10.1097/sle.0b013e3182523fa3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Many materials are currently being used to reinforce the crural repair. Perforation, intensive fibrosis, and price are limiting the usage of these materials. Our purpose was to seek an alternative, cheap, always available, and inert material to use for cruroplasty reinforcement. METHODS Twenty-four patients participated and were randomly divided into 2 groups (graft+laparoscopic Nissen fundoplication and laparoscopic Nissen fundoplication alone) with 12 patients in each group. Total operation time, postoperative dysphagia rate, dysphagia improvement time, postoperative pain, recurrence, and incisional hernia rate were compared. RESULTS There was no difference in terms of study parameters between both groups except for the mean operation time. CONCLUSIONS Autograft hiatoplasty seems to be a good alternative for crural reinforcement. It provides safe reinforcement, has the same dysphagia rates as meshless hiatoplasty, and avoids potential complications of redo surgery by minimizing extensive fibrosis. Furthermore, the rectus abdominus sheath is always available and inexpensive.
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Maheshkumar GS, Jani K, Madhankumar MV, Palanivelu C. Laparoscopic redo fundoplication for intrathoracic migration of wrap. J Minim Access Surg 2011; 3:111-3. [PMID: 19789668 PMCID: PMC2749186 DOI: 10.4103/0972-9941.37195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 03/16/2007] [Indexed: 11/04/2022] Open
Abstract
Laparoscopic fundoplication is fast emerging as the treatment of choice of gastro-esophageal reflux disease. However, a complication peculiar to laparoscopic surgery for this disease is the intrathoracic migration of the wrap. This article describes a case of a male patient who developed this particular complication after laparoscopic total fundoplication. Following a trauma, wrap migration occurred. The typical history and symptomatology is described. The classical Barium swallow picture is enclosed. Laparoscopic redo fundoplication was carried out. The difficulties encountered are described. Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology. Confirmation is by a Barium swallow. Treatment is by redo surgery.
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Affiliation(s)
- G S Maheshkumar
- Department of Minimal Access Surgery, GEM Hospital, 45A, Pankaja Mill Road, Coimbatore - 641 045, India
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Mesh erosion as a complication of laparoscopic fundoplication with prosthetic hiatal closure: report of a case. Surg Laparosc Endosc Percutan Tech 2010; 19:e51-4. [PMID: 19390264 DOI: 10.1097/sle.0b013e3181979a45] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic fundoplication has become the standard procedure for surgical management of gastroesophageal reflux disease. Simple cruroplasty is associated with a high recurrence rate and most authors recommend the use of prosthetic meshes for crural closure. METHODS Herein we report a patient who was admitted with the complaint of severe dysphagia a year after laparoscopic fundoplication with prosthetic hiatal closure. RESULTS The patient presented with mesh erosion into the esophagus and required a distal esophageal resection. CONCLUSIONS This case demonstrates that appropriate surgical technique is important for preventing mesh-related complications. A small-sized mesh should be placed so as to have no contact with the esophagus and should be secured sufficiently to the diaphragmatic crura to avoid the potential complications of mesh reinforcement.
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Carpelan-Holmström M, Kruuna O, Salo J, Kylänpää L, Scheinin T. Late mesh migration through the stomach wall after laparoscopic refundoplication using a dual-sided PTFE/ePTFE mesh. Hernia 2010; 15:217-20. [PMID: 20130942 DOI: 10.1007/s10029-010-0633-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 01/15/2010] [Indexed: 12/16/2022]
Abstract
We report a rare complication after laparoscopic fundoplication using a dual-sided PTFE/ePTFE (Bard® Crurasoft™) mesh fixation. A 53-year-old man was re-operated for a recurrent hiatal hernia. The hiatal hernia was reinforced using a mesh. Two years later, the patient presented with serious dysphagia and weight loss. An endoscopy revealed a migrated mesh in the stomach. The mesh was excreted within the stool without notice. The PTFE/ePTFE mesh, which is designed for treating hiatal defects, is considered to have superior tissue incorporation, together with less adhesion formation and fistulation. As mesh migration into the upper gastrointestinal tract is possible, it should be used with great care in the peri-oesophageal region.
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Affiliation(s)
- M Carpelan-Holmström
- Department of Surgery, Helsinki University Central Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland.
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Müller-Stich BP, Köninger J, Müller-Stich BH, Schäfer F, Warschkow R, Mehrabi A, Gutt CN. Laparoscopic mesh-augmented hiatoplasty as a method to treat gastroesophageal reflux without fundoplication: single-center experience with 306 consecutive patients. Am J Surg 2009; 198:17-24. [DOI: 10.1016/j.amjsurg.2008.07.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 07/11/2008] [Accepted: 07/11/2008] [Indexed: 01/10/2023]
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Zügel N, Lang RA, Kox M, Hüttl TP. Severe complication of laparoscopic mesh hiatoplasty for paraesophageal hernia. Surg Endosc 2009; 23:2563-7. [PMID: 19440795 DOI: 10.1007/s00464-009-0456-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 03/07/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several studies have shown that laparoscopic hernia repair for large paraesophageal hiatal hernia is associated with a high recurrence rate. Therefore, some authors recommend the use of prosthetic meshes. Considering the dynamic area between the esophagus and the diaphragmatic crura with its constant motion, it is astonishing that only a minor number of surgeons describe mesh-associated complications. METHODS Between January 2000 and August 2008, 26 patients of the Centre Hospitalier Emile Mayrisch (CHEM, Luxembourg) underwent laparoscopic repair for large paraesophageal hiatal hernia (median age, 70 (range, 39-90) years). In nine patients, prosthetic mesh reinforcement was performed (7 composite/2 mono-phase mesh). Crural repair without tension was performed only with sutures. There were no conversions. Follow-up assessment was prospective with the GIQL (Gastro-Intestinal Quality of Life) Index. RESULTS Responses to the GIQLI questionnaires were obtained from 20 patients (6 died of unrelated causes). Nineteen patients were satisfied with their symptom control 1 year after the operation (GIQLI 127). Sixteen patients had radiological follow-up (median, 24 months). Three patients treated without mesh (3/10) showed a radiological recurrence. All of them (3/10) had symptoms. None of the controlled patients with mesh (0/6) showed a recurrence. One patient developed a severe aortal bleeding 1, 2, and 3 weeks after the laparoscopic mono-phase mesh repair. During conventional operation, the bleeding stopped. Three years later, the follow-up showed a satisfied patient (GIQLI 127). CONCLUSIONS In view of the described complication, there is still considerable controversy regarding the routine use of mesh. To increase safety, a composite mesh should be preferred.
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Affiliation(s)
- Nico Zügel
- General and Visceral Surgery Unit, Centre Hospitalier Emile Mayrisch, Rue Emile Mayrisch, 4005, Esch-sur-Alzette, Luxembourg.
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Quilici PJ, McVay C, Tovar A. Laparoscopic antireflux procedures with hepatic shoulder technique for the surgical management of large paraesophageal hernias and gastroesophageal reflux disease. Surg Endosc 2009; 23:2620-3. [PMID: 19360367 DOI: 10.1007/s00464-009-0452-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Revised: 02/12/2009] [Accepted: 03/03/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Large paraesophageal hernias are notoriously difficult to manage via laparoscopy and are associated with a significant recurrence rate. A novel laparoscopic approach was used to close the diaphragmatic defect in four patients diagnosed with large, paraesophageal hernias and gastroesophageal reflux disease symptomatology. METHODS All procedures were performed via laparoscopy. Three patients underwent a reduction of the paraesophageal hernia with a Nissen fundoplication and one with Collis-Nissen fundoplication. Standard crural closure was performed over a #60 Fr Bougie in two patients, and two patients did not undergo a cruroplasty. In all four patients, the left hepatic lobe was freed, repositioned, and anchored under and inferior to the gastroesophageal junction, propping the gastroesophageal junction anteriorly. This maneuver entirely covers and closes the diaphragmatic defect. RESULTS Postoperatively, all patients did well without notable, unusual complaints. Average length of stay was 2 days. Although not statistically significant, all patients had no recurrence of symptoms or of their paraesophageal hernia at 8, 9, 11, and 15 months after the procedure. CONCLUSIONS In selected patients, large paraesophageal hernias can safely be managed via a laparoscopic antireflux procedure with the hepatic shoulder technique. Although no long-term follow-up is available, this technique has shown good early postoperative results and may be used as an alternative to a laparoscopic Mesh reinforced fundoplication or difficult crural closure.
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Affiliation(s)
- Philippe J Quilici
- Department of Surgery, Providence Saint Joseph Medical Center, 201 South Buena Vista Street, Suite 425, Burbank, CA 91505, USA.
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Are Surgisis biomeshes effective in reducing recurrences after laparoscopic repair of large hiatal hernias? Surg Laparosc Endosc Percutan Tech 2008; 18:433-6. [PMID: 18936659 DOI: 10.1097/sle.0b013e3181802ca7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prosthetic repair is frequently advocated after repair of large hiatal hernias, and biomeshes have been proposed to help reduce the high recurrence rate. All patients undergoing laparoscopic repair of primary or recurrent large hiatal hernia, and with intraoperative finding of weak diaphragmatic pillars, as judged by the surgeon, were included, from June 2004 to July 2005, in a prospective observational study. In these patients, Surgisis biomeshes were employed to assist the repair. Six patients (4 for primary and 2 for recurrent hernia) received biomesh hiatoplasty. Four had mild dysphagia at 1 month that disappeared at the next follow-up. Three had slow radiologic transit through the esophagogastric junction, still present in 1 patient at 1 year. One patient had hernia recurrence 6 months after surgery and 2 other patients had radiologic recurrence of a small hernia at 1-year follow-up; in all 3, the recurrence was small and asymptomatic and none were reoperated. The short-term recurrence rate using biomesh for the laparoscopic repair of large hiatal hernias in patients with weak diaphragmatic pillars was high at 50%. Postoperative morbidity and mesh-related complications were almost absent. Biomeshes can be safely used as on lay reinforcement in hiatoplasty, but do not reduce the hiatal recurrence rate.
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Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ, Michael Brunt L, Hunter JG, DeMeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 2008; 23:1219-26. [DOI: 10.1007/s00464-008-0205-5] [Citation(s) in RCA: 285] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Revised: 08/28/2008] [Accepted: 10/04/2008] [Indexed: 12/16/2022]
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Müller-Stich BP, Mehrabi A, Kenngott HG, Fonouni H, Reiter MA, Kuttymoratov G, Nickel F, Linke GR, Wolf I, Köninger J, Gutt CN. Is a circular polypropylene mesh appropriate for application at the esophageal hiatus? Results from an experimental study in a porcine model. Surg Endosc 2008; 23:1372-8. [PMID: 18855052 DOI: 10.1007/s00464-008-0185-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Revised: 07/29/2008] [Accepted: 08/13/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mesh reinforcement in hiatal hernia surgery is debated. Randomized controlled trials have shown that recurrences may be reduced, but there is also the fear of mesh-related complications. Experimental studies on the characteristics of specific mesh types with regard to the risk of such complications are rare. The current study aimed to investigate the properties of a circular heavy-weight polypropylene mesh in terms of stenosis, migration, erosions, and adhesions in a porcine model. METHODS A 55 x 55-mm heavy-weight polypropylene mesh with a 16.5-mm eccentric hole for the esophagus corresponding to a calculated mesh area of 2811 mm(2) and a hole area of 214 mm(2) were implanted in nine German Landrace pigs. Six weeks later, the meshes were explanted and investigated for size, shrinkage, migration and adhesions. RESULTS The total mesh area shrank to a mean of 2,040 +/- 178 mm(2) (p < 0.001), and the hole for the esophagus showed a trend toward an increase to 239 +/- 38 mm(2) (p = 0.108). In not a single location did the mesh overhang the hiatal margin. The mean distance of retraction from the hiatal margin was 4.3 +/- 2.8 mm. Therefore, no stenoses, migrations, or erosions occurred. CONCLUSIONS A circular heavy-weight polypropylene mesh seems to be appropriate for the application at the esophageal hiatus in terms of safety and stability. This means that it is characterized by a position-stable centered fixation around the esophagus without a tendency toward stenosis, migration, or erosion.
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Affiliation(s)
- Beat P Müller-Stich
- Department of General, Abdominal, and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Granderath FA, Granderath UM, Pointner R. Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg 2008; 32:999-1007. [PMID: 18373118 DOI: 10.1007/s00268-008-9558-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Failure of hiatal closure has proven to be the most frequent complication leading to revisional surgery after primary failed open or laparoscopic antireflux surgery. To prevent hiatal hernia recurrence some authors recommend the use of prosthetic meshes for reinforcement of the hiatal crura. The aim of the present prospective study was to evaluate the safety and effectiveness of a circular hiatal onlay mesh prosthesis applied during laparoscopic refundoplication after primary failed antireflux surgery with intrathoracic wrap migration. The follow-up period was 5 years. METHODS A total of 33 patients underwent laparoscopic refundoplication for recurrent symptoms of gastroesophageal reflux disease after primary failed laparoscopic or open antireflux surgery. The underlying morphological complication for symptom recurrence in all patients was hiatal hernia recurrence with intrathoracic migration of the fundoplication. During revisional surgery, after breakdown of the former fundoplication, the esophageal hiatus was thoroughly revised and a circular polypropylene mesh was used to buttress the primarily simple sutured hiatal crura. Additionally, in all patients a refundoplication was performed. Recurrences, complications, functional data, esophagogastroduodenoscopy, and cinematographic X-ray results, as well as quality of life data, were evaluated for the 60-month follow-up period. RESULTS All reoperations were successfully completed laparoscopically. Twenty-one patients underwent laparoscopic 360 degrees "floppy" Nissen refundoplication, and 12 patients underwent laparoscopic 270 degrees Toupet refundoplication. Hiatal closure was performed by placing a circular polypropylene sheet that had a 3-4 cm keyhole for the esophageal body. Of 24 patients who underwent redo-surgery before May 2000, no patient developed a recurrent hiatal hernia during the first 12 postoperative months. All 33 patients were re-evaluated and underwent complete diagnostic work-up over a follow-up period of 60 months postoperatively. During the long-term follow-up, a new recurrent hiatal hernia with intrathoracic wrap migration developed in 2 patients (6%). In both cases, slippage occurred anteriorly to the esophagus. Both patients were scheduled for repeat refundoplication. In all other patients no recurrence occurred for the complete follow-up period, and no mesh-related complications developed. CONCLUSIONS Laparoscopic refundoplication for primary failed hiatal closure with the use of a circular mesh prosthesis is a safe and effective procedure to prevent hiatal hernia recurrence for short- and mid-term follow-up. However, for long-term follow-up, even with the placement of prosthetic mesh, re-recurrence occurs in some patients, leading to repeated surgery.
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Affiliation(s)
- F A Granderath
- Department of General, Visceral and Transplant Surgery, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tubingen, Germany.
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Abstract
BACKGROUND Breakdown of the crural closure is a frequent reason for failure of antireflux surgical procedures. This retrospective study aimed to determine the effectiveness of using absorbable mesh in preventing recurrence of hiatal hernia after posterior cruroplasty. DESIGN Comparative retrospective analysis. METHOD The charts of 220 adults who underwent antireflux surgery with posterior cruroplasty between 1997 and 2005 were retrospectively reviewed. Patients were divided into 2 groups: posterior cruroplasty+absorbable mesh reinforcement (n=127) and posterior cruroplasty alone (n=93). Symptomatic outcome was assessed by telephone interview in 92 patients (72%) in the mesh group at a median of 3.2 years postoperatively and 59 patients (63%) in the no mesh group of men studied at a median of 3.8 years postoperatively. MAIN OUTCOME MEASURES Incidence of recurrence and persistent symptoms. RESULTS In the mesh group, 74/92 (80%) patients remained asymptomatic at a median of 3.2 years postoperatively. Of these patients, 31 underwent either an upper endoscopy or an upper gastrointestinal (UGI) series; none had recurrence of hiatal hernia. Of the 18 symptomatic patients, 13 underwent an upper endoscopy or an UGI series to determine the etiology of symptoms; 3 recurrences were confirmed for a 3.3% overall proven recurrence rate. In the no mesh group, 26/59 (44%) patients were symptomatic. Of these, 18 underwent either an upper endoscopy or an UGI series. Recurrence of hernia was confirmed in 12 patients for a 20% overall proven recurrence rate. There were no instances of mesh infection or erosion. CONCLUSIONS Symptomatic recurrence rates of hiatal hernia after antireflux surgery vary. Recurrence of a hiatal hernia may or may not lead to symptoms. This retrospective analysis demonstrates that absorbable mesh is safe and may lead to a significant reduction in the incidence of symptomatic recurrent hiatal hernia.
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Kepenekci I, Turkcapar AG. Reply. World J Surg 2007. [DOI: 10.1007/s00268-007-9367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Varga G, Cseke L, Kalmar K, Horvath OP. Laparoscopic repair of large hiatal hernia with teres ligament: midterm follow-up: a new surgical procedure. Surg Endosc 2007; 22:881-4. [PMID: 17973164 DOI: 10.1007/s00464-007-9648-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 08/14/2007] [Accepted: 09/05/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although laparoscopic repair of large, mostly paraesophageal hiatal hernias is widely applied, there is a great concern regarding the higher recurrence rate associated with this procedure. In order to reduce this high recurrence rate, several techniques have been developed, mostly applying a mesh prosthesis for hiatal reinforcement. METHODS We have recently introduced a new laparoscopic technique in which the hiatal closure is reinforced with the teres ligament. To date 26 patients have been entered into this ongoing prospective study. After the operation patients were called back on a regular basis for symptom evaluation and barium swallow. All 26 patients agreed to undergo barium swallow, with a mean follow-up of 35 months. RESULTS The mean operative time was 115 min. Perioperative morbidity was 11.5%, and conversion to an open procedure was performed in six cases. No mortality was registered. Anatomic recurrence, investigated by barium swallows was observed in four patients (15.3%). Of those four, only one (3.85%) had a symptomatic recurrent paraesophageal hernia; the other three had asymptomtic sliding hernias. In three of the four patients with anatomic recurrence, the diameter of the hiatal hernia was greater than 9 cm at the original operation, and the fourth patient underwent reoperation for recurrent hiatal hernia. No symptomatic recurrence was found in patients with diameter of hiatal hernia between 6 and 9 cm. CONCLUSIONS Laparoscopic reinforcement of the hiatal closure with the ligamentum teres is safe and effective treatment for large hiatal hernias. However, it appears that patients with extremely large hiatal hernias are at greater risk of recurrence, and therefore large hernias are not suitable for this new technique.
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Affiliation(s)
- G Varga
- Department of Surgery, Medical Faculty University of Pécs, H-7643, Pécs, Ifjúság u.13, Hungary.
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Turkcapar A, Kepenekci I, Mahmoud H, Tuzuner A. Laparoscopic fundoplication with prosthetic hiatal closure. World J Surg 2007; 31:2169-76. [PMID: 17610010 DOI: 10.1007/s00268-007-9066-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2007] [Revised: 02/24/2007] [Accepted: 03/04/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the good results reported after laparoscopic fundoplication, failure is still a major problem. Hiatal disruption is one of the common patterns of anatomical failure. The aim of this study was to compare the results of suture repair of diaphragmatic crura with routine polypropylene mesh reinforcement in addition to suture repair. METHODS A total of 551 patients who underwent laparoscopic fundoplication for gastroesophageal reflux disease between March 1998 and July 2004 were included into the study. Crural closure had been performed with simple primary suture repair alone between March 1998 and July 2002 (n = 335, group I), and mesh reinforcement of the hiatal repair was performed routinely thereafter (n = 176, group II). These groups were evaluated prospectively. RESULTS We observed a significantly lower rate of recurrence in group II than in group I. After a 2-year follow-up, the rate of anatomic morphologic recurrence was 6.0% in group I and 1.8% in group II. Considering the recurrence rate, there was significant statistical difference. The overall recurrence rate in our series was 4.6%. There was no correlation between the size of the hernia and recurrence. No significant difference was found between groups regarding the rate of postoperative dysphagia. We have not observed any complications related to the use of polypropylene mesh in group II. CONCLUSION The results of this study suggest that polypropylene mesh reinforcement increases the success rate for laparoscopic hiatal hernia repair without causing an additional complication burden. We propose routine use of mesh reinforcement in laparascopic antireflux surgery.
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Affiliation(s)
- Ahmet Turkcapar
- Department of General Surgery, Ankara University School of Medicine, AUTF Ibni Sina Hastanesi Ek Bina K4 Samanpazar, Ankara 06100, Turkey.
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