腹腔镜补片修补巨大食管裂孔疝

目的探讨腹腔镜补片修补巨大食管裂孔疝的安全性和有效性。方法 2006年5月至2010年5月应用腹腔镜补片修补食管裂孔疝12例,采用全身麻醉,材料为聚丙烯和聚四氟乙烯补片,剪裁7.5cm×7.5cm大小圆形补片,用EMS固定于膈肌上。结果全部患者手术成功。术后1个月复查,症状按Visick评分：12例均为VisickⅠ。胃镜检查：食管下端糜烂减轻或消失。食管压力测定：（16.33±3.07）mmHg。24h食管内pH值〈4,总时间百分比均〈4%。钡餐检查：12例胸腔胃全部位于膈下腹腔内。12例患者随访1～5年,无胃烧灼感、反流症状,胃镜食管炎消失,钡餐食管裂孔疝无复发。5例贫血者,血色素升至正常。结论腹腔镜下补片修补食管裂孔疝安全、有效且复发率低。补片相关并发症需进一步随访观察。     

复合补片和生物补片治疗食管裂孔疝的疗效对比研究

目的:对比应用复合补片和生物补片治疗反流性食管炎和食管裂孔疝的疗效。方法:21例应用Crurasoft誖复合补片组及20例应用BiodesignTM Surgisis誖生物补片组修补食管裂孔疝病人,对比分析术后复发率和补片相关并发症发生的差异。结果:两组病人一般情况、食管裂孔长径和手术时间等方面无统计学差异。应用复合补片和生物补片均能使术前反流性食管炎的症状显著缓解。复合补片组和生物补片组围手术期并发症发生率分别为9.5%和30.0%,两组间无统计学差异。术后6个月随访裂孔疝复发率均为0。复合补片组和生物补片组长期随访平均时间分别为(16.3±8.9)个月和(17.3±6.8)个月,解剖性复发率分别为4.8%和5.0%,无统计学差异。两组病人均未发生食管侵蚀的并发症。复合补片组病人术后吞咽困难发生率高于生物补片组(38.1%比20..0%),但无统计学差异。结论:应用新一代小肠黏膜下基质补片和复合补片修补食管裂孔疝后疗效满意,复发率低,补片相关的严重并发症发生率差异无统计学意义。     

腹腔镜食道裂孔疝修补术的临床效果分析：附51例报告

目的:探讨腹腔镜食道裂孔疝修补术的安全性和疗效。方法:回顾分析2012年7月—2016年7月51例行腹腔镜食道裂孔疝修补术的患者临床资料。结果:51例患者均顺利接受腹腔镜食道裂孔疝修补术。术中裂孔缝合修补后均采用补片加强固定。对无明显禁忌证患者,同时行Dor胃底折叠术。平均时间(100±15.4)min,术中出血量平均(28±15.4)mL,术后平均住院时间2d。术后胸痛、进食后哽噎等疝囊压迫症状明显缓解,反酸,烧心等反流症状也得到明显改善。无严重并发症发生,均在4周内恢复正常饮食。平均随访32个月,未见裂孔疝复发及补片相关并发症。结论:腹腔镜食道裂孔疝修补术是安全有效的手术方式,食道裂孔缝合关闭后使用补片加强修补可以降低裂孔疝的复发率。     

生物补片与自固定补片在腹股沟疝修补术中的临床对照研究

目的对比猪小肠黏膜下层脱细胞基质生物补片和自固定人工合成聚丙烯补片在腹股沟疝Lichtenstein修补术中应用的临床疗效。 方法回顾性分析2019年5月至2020年4月于天津市南开医院胃肠疝外科行Lichtenstein修补术的96例初发单侧腹股沟疝患者的临床资料，按照修补材料不同分为SIS组（使用猪小肠黏膜下层脱细胞基质材料生物补片）和SGPP组（使用自固定人工合成聚丙烯补片）。对比2组的一般情况、手术情况及术后并发症情况，评价两种修补材料的安全性和临床疗效。 结果SIS组46例，SGPP组50例，2组患者一般资料差异无统计学意义（P>0.05）。SIS组手术时间（62.61±6.89）min显著长于SGPP组（59.60±5.13）min（t=2.438，P=0.017）。2组在住院时间、术后第1天疼痛评分、血清肿、切口感染、复发、慢性疼痛、补片感染等方面，差异无统计学意义（P>0.05）。 结论与自固定人工合成聚丙烯补片相比，猪小肠黏膜下层脱细胞基质生物补片应用于成人腹股沟疝Lichtenstein修补术具有相同的临床疗效及安全性，但其长期疗效仍有待进一步研究。     

轻量聚丙烯补片与自固定补片在Lichtenstein疝修补术的研究

目的对比研究轻量大网孔聚丙烯补片与自固定补片在Lichtenstein疝修补术中的应用。 方法选择2021年1-3月在吉林大学第二医院60例单侧男性腹股沟疝患者行前瞻性随机对照研究,随机分为轻量大网孔聚丙烯补片组和自固定补片组各30例,分别应用轻量大网孔聚丙烯补片和自固定补片进行Lichtenstein疝修补术;对比2组一般资料、手术相关指标、术后平均住院时间、血清肿、补片感染、术后疼痛、复发、异物感以及治疗费用等相关情况进而评价两种补片的治疗效果。 结果2组患者一般资料、手术麻醉方式、术后住院时间比较差异无统计学意义（P>0.05）,2组的平均手术时间和治疗费用差异有统计学意义（P<0.05）;术后血清肿、术后短期（7 d及1个月）疼痛和慢性疼痛、补片感染、局部不适或异物感、复发等并发症差异均无统计学意义。 结论自固定补片可明显缩短手术时间,但医疗费用明显高于轻量大网孔聚丙烯补片,在术后复发和慢性疼痛等并发症方面差异不显著。     

标准聚丙烯补片与部分可吸收补片在腹股沟疝腹膜前修补术中的疗效

目的比较标准聚丙烯补片与部分可吸收补片在腹股沟疝腹膜前修补中的差异。 方法采用前瞻性随机对照的研究方法，对2018年1至9月吉林大学第二医院148例单侧男性腹股沟疝患者随机分为标准聚丙烯补片组（PM组，73例）和部分可吸收补片组（PAM组，75例），分别应用标准聚丙烯补片和部分可吸收补片进行腹膜前腹股沟疝修补术。术后分别观察2组的术后平均住院时间、血清肿、补片感染、术后疼痛、复发、异物感以及治疗费用等相关情况，并应用生活质量评价量表（SF-36）评估其生活质量。 结果2组患者术后平均住院时间、血清肿发生率、补片感染率、复发率均比较，差异均无统计学意义（P>0.05）；术后6个月疼痛感、局部异物感和治疗费用比较，差异均有统计学意义（P<0.001、0.016 8、<0.001）；2组患者术后SF-36评分比较，差异无统计学意义（P>0.05）。 结论应用部分可吸收补片可改善患者术后疼痛和异物感的情况，但是需要较高的治疗费用；标准聚丙烯补片与部分可吸收补片均不影响患者术后的生活质量。     

不同类型补片在食管裂孔疝修补术中应用的研究

目的:探讨生物补片和合成补片在食管裂孔疝修补术中的临床效果。方法:采用前瞻性队列研究,纳入2019年5月至2020年1月首都医科大学附属朝阳医院疝和腹壁外科收治的60例食管裂孔疝患者,分析选择应用生物补片或合成补片完成腹腔镜食管裂孔疝修补加胃底折叠术患者的临床资料,比较使用生物补片和合成补片的两组患者手术时间、术中出血...     

防粘连细菌纤维素复合补片动物模型的建立及实验研究

目的将防粘连细菌纤维素复合补片应用于大鼠实验中,进一步探索并验证该补片腹腔内的防粘连效果,为新型补片的研发提供理论基础。方法采用随机数字表法将48只成年Wistar大鼠平均分成2组(每组24例),分别为聚丙烯组(PP组)、防粘连复合补片组(PP/BC组)。每组再随机平均分成2个亚组(每组12例),即短期组(10 d)和长期组(60 d),分别予植入后10 d和60 d肉眼观察补片粘连情况,并取补片及其周围腹壁组织进行组织学观察,比较及评价各组补片的抗粘连效果。结果术后第10天,细菌纤维素复合补片防粘连评分明显优于聚丙烯补片(P0.05)。复合补片周围新生细胞外沉积较多(P0.05),腹腔侧有更明显的纤维结缔组织覆盖,较少的炎细胞浸润(P0.05)。术后第60天,细菌纤维素复合补片粘连评分与聚丙烯补片相比,差异无统计学意义(P0.05),炎细胞浸润较多、多核巨细胞浸润较少(P0.05)。结论细菌纤维素复合补片腹腔内修补的防粘连效果较佳,是一种潜在的腹腔内防粘连疝补片,但能否临床转化仍需进一步研究。     

自固定补片与普通聚丙烯补片临床应用对比分析

目的比较自固定补片与普通聚丙烯补片在Litchenstein腹股沟疝修补术后患者的手术时间、手术效果及并发症等情况。方法回顾性分析2011年11月至2013年3月,陕西省人民医院收治的单侧腹股沟疝患者24例,随机分为二组,每组12例,对自固定补片疝修补组（试验组）与普通聚丙烯补片疝修补组（对照组）进行临床对照研究,观察术后疼痛VAS评分、手术时间、术后并发症及复发情况。结果试验组与对照组术后4、8、12h疼痛差异无统计学意义（t=1．632、1．451、1．402,P=0．059、0．079、0．094）,但术后24h试验组较对照组明显减轻,且术后1个月时有更好的舒适感（t=2．793、1．856,P=0．009、0．040）;试验组手术时间（29±5）min,对照组手术时间（36±7）min,二组比较差异有统计学意义（t=2．156,P=0．034）;随访2～17个月,二组均无出现并发症及复发。结论在Litchenstein腹股沟疝修补术中,自固定补片相比普通聚丙烯补片可有效减轻患者术后疼痛,且手术安全,操作简单。     

腹腔镜在食管裂孔疝修补术中的临床应用

目的探讨腹腔镜在食道裂孔疝修补术中应用的疗效及安全性。方法运用腹腔镜对21例食道裂孔疝患者行食道裂孔疝修补术,其中13例食道裂孔缺损≥4 cm者使用巴德Cru-raSoft补片进行修补,8例缺损4 cm者用2-0普理灵缝线连续缝合将两膈肌脚关闭。同时将胃底固定于食道左侧膈肌下,以恢复锐性His角。结果 21例均顺利完成疝修补术,无中转开腹,未出现并发症。平均手术时间117 min;平均出血量约36.7 ml;平均住院日3.7 d。术后3个月行胃镜复查,显示患者的食道炎均已明显好转,未见消化性溃疡或糜烂性胃炎;术后随访3～30个月,单纯缝合修补者有2例复发。结论对于老年人要适当控制气腹的压力。腹腔镜手术的高清晰度、宽广视野是直视手术所无法比拟的,用以治疗食道裂孔疝有手术损伤小、出血少、患者恢复快、住院时间短等优点,其并发症的发生率和死亡率都比开腹直视手术要低。腹腔镜下行食道裂孔疝修补的治疗是安全可行的,值得临床推广应用。     

Laparoscopıc Fundoplicatıon with Prosthetic Hiatal Closure

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. An erratum to this article can be found at     

Does the use of bioabsorbable mesh for hiatal hernia repair at the time of bariatric surgery reduce recurrence rates? A meta-analysis

BackgroundAnywhere from 16% to 37% of patients undergoing bariatric and metabolic surgery are estimated to have a hiatal hernia. To address the lack of long-term data showing the efficacy of bioabsorbable mesh in reducing the recurrence of hiatal hernia in patients who undergo bariatric surgery, we evaluated the world literature and performed a meta-analysis.ObjectiveTo evaluate hiatal hernia recurrence rates after placement of bioabsorbable mesh in bariatric patients.SettingMeta-analysis of world literature.MethodsWe performed a literature search using PubMed and MEDLINE with search terms including “hiatal hernia recurrence,” “bariatric surgery,” “bioabsorbable mesh,” “Gore BIO-A,” and “trimethylene carbonate.” Analysis was conducted to compare surgical time, length of stay, recurrence rate, hernia size, and changes in body mass index before and after surgery between mesh-group (MG) and nonmesh (NM) patients. The meta-analysis was described using standardized mean difference, weighted mean difference, effect size, and 95% confidence interval (CI). An I² statistic was computed to assess heterogeneity.ResultsTwelve studies with 1351 patients were included in our meta-analysis. Four studies had both an MG and an NM group. There were 668 patients in the MG and 683 patients in the NM group. Hernia size noted in the NM group (7 cm²) was compared with that in the MG (6.5 cm²) (95% CI: 3.89–9.14; P = .86). The MG had fewer recurrences than the NM group (effect size, 2% versus 14%; 95% CI: –.26 to –.02; P = .027). The average follow-up was 28.8 months for the MG and 32.8 months for the NM group.ConclusionRepair with bioabsorbable mesh at the time of the index bariatric surgery is more effective at reducing the recurrence rate of hiatal hernia than suture cruroplasty. Further studies investigating the long-term outcomes of bioabsorbable mesh placed at the time of bariatric surgery are needed.     

Comparison of Prosthetic Materials in Incisional Hernia Repair

Purpose Incisional hernias are not uncommon after abdominal surgery, but their repair is associated with a high risk of complications, including adhesions and recurrence. Many different types of meshes and adhesion barriers have been developed in an attempt to overcome these problems, some of which we have assessed in a rat model.Methods We made a full-thickness 1.5 × 2.5-cm abdominal wall defect in 30 Sprague-Dawley rats, which were divided into three groups according to the materials used for repair: 2 × 3-cm polypropylene mesh (group 1); expanded polytetrafluoroethylene (PTFE) with double-layer polypropylene mesh (group 2); or polypropylene mesh with oxidized cellulose adhesion barriers (group 3). We assessed adhesion formation, tensile strength, and histopathologic findings.Results The mean adhesion scores were 3.3, 1.3, and 0.7, in groups 1, 2, and 3, respectively (P < 0.001). The area involved by adhesions was significantly greater in group 1 than in groups 2 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 2 and 3 (P < 0.05). The tensile strength in group 2 was less than that in groups 1 or 3 (P < 0.01, P < 0.05), but there was no significant difference between groups 1 and 3 (P > 0.05).Conclusion Although there was less adhesion formation with PTFE and oxidized cellulose, PTFE not only impaired the tensile strength, but also induced fibrosis and inflammation. An oxidized cellulose adhesion barrier can be safely used in incisional hernia repair to prevent intra-abdominal adhesions.     

Primary closure of laparotomies with high risk of incisional hernia using prosthetic material: analysis of usefulness

Incisional hernia continues to be a serious postoperative complication in abdominal surgery. We present a prospective randomised study to evaluate the usefulness of placement of a supra-aponeurotic polypropylene mesh in the primary closure of laparotomies with a high risk of incisional hernia. Closure of a vertical laparotomy in 100 patients was accomplished with continuous suture using non-reabsorbable material, with placement of a polypropylene mesh on the aponeurotic surface in 50 patients. Three years after surgery, five patients in the group without the mesh had suffered incisional hernia. No incisional hernia was detected in the group in which closure was made using the mesh (P=0.02). Use of prosthetic material (polypropylene mesh) in the primary closure of laparotomies with a high risk of incisional hernia is useful for reduction of the rate of incisional hernias.     

N-Butyl Cyanoacrylate Versus Conventional Suturing for Fixation of Meshes in an Incisional Hernia Model

ABSTRACT

Background: Chronic pain and related complications reported after the use of perforating fixation devices in hernia surgery have led to the use of tissue sealants. Fibrin sealant is a feasible option for mesh fixation; however data on cyanoacrylate glues are limited. Methods: 32 Sprague-Dawley rats were divided into two groups and a 1.5 cm abdominal wall defect was created on each animal. The lesions were then repaired with 2 × 2 cm polypropylene meshes, fixed with n-butyl-cyanoacrylate in the first group and with polypropylene sutures in the second group. The rats were sacrificed on the 21st and 42nd days. The presence of infection, recurrence, and abdominal adhesions were evaluated, followed by biomechanical testing and histological examination. Results: No mesh infection or hernia recurrences were recorded. There was no statistically significant difference between neither the adhesion scores nor the mean broken pressure of the two groups. Cyanoacrylate sealing was found equivalent to suturing in terms of tissue ingrowth, fibrosis, inflammatory infiltration, abscess formation, and necrosis. Furthermore, cyanoacrylate resulted in less foreign body reaction. Conclusions: Mesh fixation by cyanoacrylate may be considered as an alternative to suture fixation.     

The effect of diaphragmatic stressors on recurrent hiatal hernia

Abstract. Hiatal disruption is one of the common mechanisms of failure after Nissen fundoplication. We investigated the correlation between various diaphragm stressors and disruption of the diaphragmatic closure. Thirty-seven patients with a hiatal hernia recurrence of 2 cm or greater, as proven by esophagram, endoscopy, or operative findings, were included. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire for the study group and a control group of 50 patients without hiatal hernia recurrence. Logistic regression was used to determine the significant predictors of hiatal hernia recurrence. Three predictors emerged in the final model: weight lifting (P<0.0174), vomiting (P<0.0313) and hiccoughing (P<0.2472). Of these, only vomiting and weight lifting were significant. The odds ratio for weight lifting is OR=3.662 (95% CI: 1.256–10.676), and for vomiting it is OR=4.938 (95% CI: 1.154–21.126). Vomiting or heavy weight lifting is a significant predictor of hiatal hernia recurrence. Electronic Publication     

Long-term results of hiatal hernia mesh repair and antireflux laparoscopic surgery

Background

Laparoscopic antireflux surgery (LARS) represents the gold standard in the treatment of gastroesophageal reflux disease with or without hiatal hernia. It offers excellent long-term results and high patient satisfaction. Nevertheless, several studies have reported a high rate of intrathoracic wrap migration or paraesophageal hernia recurrence. To reduce the incidence of this complication, the use of prosthetic meshes has been advocated. This study retrospectively evaluated the long-term results of LARS with or without the use of a mesh in a series of patients treated from 1992 to 2007.

Methods

From November 1992 to May 2007, 297 patients underwent laparoscopic antireflux surgery in the authors’ department. Crural closure was performed by means of two or three interrupted nonabsorbable sutures for 93 patients (group A), by tailored 3 × 4-cm polypropylene mesh placement for 113 patients (group B), and by nonabsorbable suture plus superimposed tailored mesh for 91 patients (group C).

Results

The mean follow-up period for the entire group was 95.1 ± 38.7 months, specifically 95.2 ± 49 months for group A, 117.6 ± 18 months for group B, and 69.3 ±.17.6 months for group C. Intrathoracic Nissen wrap migration or hiatal hernia recurrence occurred for nine patients (9.6%) in group A, two patients (1.8%) in group B, and only one patient (1.1%) in group C. Esophageal erosion occurred in only one case (0.49%). Functional results and the long-term quality-of-life evaluation after surgery showed a significant and durable improvement with no significant differences related to the type of hiatoplasty.

Conclusion

Over a long-term follow-up period, the use of a prosthetic polypropylene mesh in the crura for hiatal hernia proved to be effective in reducing the rate of postoperative intrathoracic wrap migration or hernia recurrence, with a very low incidence of mesh-related complications.     

“对位对线”补片固定法在腹腔镜切口疝修补术中的应用

背景与目的 切口疝的微创修补理念在疝外科界已经形成共识，腹腔镜下切口疝修补在临床上的应用越来越普及，但腔镜下的补片固定技术仍然是一个难点。本研究旨在介绍一种新式的切口疝补片固定方法并探讨其临床应用效果。方法 回顾性分析2018年1月—2019年12月中山大学附属第六医院胃肠、疝和腹壁外科120例行腹腔镜切口疝修补手术（IPOM）患者的临床资料，其中60例的补片固定方式采用“对位对线”补片固定法（观察组），另60例采用传统疝钉双圈固定方法（对照组），比较两组患者相关临床指标以及经济学指标。结果 两组患者性别、年龄、BMI、病程以及疝环最大缺损指标差异均无统计学意义（均P>0.05）。观察组的平均补片固定时间短于对照组（35.5 min vs. 47.7 min，P<0.05），平均疝钉固定数量少于对照组（36.6枚 vs. 44.2枚，P<0.05），平均术后疼痛VAS评分低于对照组（3.2分 vs. 4.6分，P<0.05），住院费用低于对照组（3.9万元 vs. 4.8万元，P<0.05）。两组患者在血清肿、补片感染发生率，术后住院时间的差异均无统计学意义（均P>0.05）。观察组和对照组平均随访26.3个月与25.8个月，观察组和对照组的切口疝复发率（1.7% vs. 5.0%，P=0.61）及术后慢性疼痛的发生率差异均无统计学意义（6.7% vs. 8.3%，P=1.00）。结论 “对位对线”补片固定法可缩短补片固定时间，减少疝钉使用数量，节约住院费用，并且可降低切口疝术后早期疼痛的发生，该方法在腹腔镜切口疝修补术中的应用是安全有效的，可在临床进行推广使用。     

Evaluation of new prosthetic meshes for ventral hernia repair

Background In hernia repair, particularly laparoscopic hernia repair, direct contact between mesh and abdominal organs cannot always be avoided. Several mesh materials and composite meshes have been developed to decrease subsequent adhesion formation. Recently, new meshes have been introduced. In an experimental rat study, their value was established and compared with that of meshes already available on the market. Methods In 200 rats, eight different meshes were placed intraperitoneally and in direct contact with abdominal viscera. The following meshes were tested: polypropylene (Prolene), e-PTFE (Dualmesh), polypropylene– polyglecaprone composite (Ultrapro), titanium–polypropylene composite (Timesh), polypropylene with carboxymethylcellulose–sodium hyaluronate coating (Sepramesh), polyester with collagen-polyethylene glycol–glycerol coating (Parietex Composite), polypropylene–polydioxanone composite with oxidized cellulose coating (Proceed), and bovine pericardium (Tutomesh). At 7 and then at 30 days postoperatively, adhesion formation, mesh incorporation, tensile strength, shrinkage, and infection were scored by two independent observers. Results Parietex Composite, Sepramesh, and Tutomesh resulted in decreased surface coverage with adhesions, whereas Prolene, Dualmesh, Ultrapro, Timesh, and Proceed resulted in increased adhesion coverage. Parietex Composite, Prolene, Ultrapro, and Sepramesh resulted in the most mesh incorporation. Dualmesh and Tutomesh resulted in significantly increased shrinkage. There were no differences in mesh infection. Parietex Composite and Dualmesh resulted in a moderate inflammatory reaction, as compared with the mild reaction the other meshes exhibited. Conclusion Parietex Composite and Sepramesh combine minimal adhesion formation with maximum mesh incorporation and tensile strength. The authors recommend the use of these meshes for hernia repair in which direct contact with the abdominal viscera cannot be avoided.     

Is a circular polypropylene mesh appropriate for application at the esophageal hiatus? Results from an experimental study in a porcine model

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 × 55-mm heavy-weight polypropylene mesh with a 16.5-mm eccentric hole for the esophagus corresponding to a calculated mesh area of 2811 mm² and a hole area of 214 mm² 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 mm² (p < 0.001), and the hole for the esophagus showed a trend toward an increase to 239 ± 38 mm² (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.