Evaluation of lightweight titanium-coated polypropylene mesh (TiMesh) for laparoscopic repair of large hiatal hernias |
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Authors: | Eric J Hazebroek Ada Ng David H K Yong Hayley Berry Steven Leibman Garett S Smith |
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Institution: | (1) Department of Surgery, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia;(2) Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Level 2, Vindin House, St Leonards, Sydney, NSW, 2065, Australia |
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Abstract: | Background The use of mesh for laparoscopic repair of large hiatal hernias may reduce recurrence rates in comparison with primary suture
repair. However, there is a potential risk of mesh-related oesophageal complications due to prosthesis erosion. The aim of
this study was to evaluate a lightweight polypropylene mesh (TiMesh) repair of hiatal hernias with particular reference to
intraluminal erosion.
Methods Data were collected prospectively on 18 consecutive patients undergoing elective laparoscopic repair of a large hiatal hernia
with the use of TiMesh between November 2004 and December 2005. Quality of life and symptom analysis was performed using QOLRAD
questionnaires preoperatively and postoperatively after 6 weeks, 6 months, 1 year and 2 years. Barium studies were performed
preoperatively and 2 years postoperatively to assess hernia recurrence. After 2 years, oesophagogastric endoscopy was performed
to assess signs of mesh-related complications.
Results All operations were completed laparoscopically. There was no 30-day mortality and median hospital stay was 2.8 days (range
2–13 days). Complications occurred in two patients (11%), both of whom were treated without residual disability. Two years
after hiatal hernia repair, there was significant improvement in quality-of-life scores (QOLRAD 5.79, p < 0.001). There was no difference between pre- and postoperative dysphagia scores. No signs of stricture formation or prosthetic
erosion were identified during endoscopic follow-up. One patient had a small (2 cm) sliding hiatal hernia demonstrated by
barium studies, which was asymptomatic.
Conclusions Laparoscopic reinforcement of primary hiatal closure with TiMesh leads to a durable repair in patients with large hiatal hernias.
Endoscopic follow-up did not show any signs of mesh-related complications after prosthetic reinforcement of the crural repair.
Our preliminary results suggest that it is safe to proceed with this lightweight polypropylene mesh for reinforcement of the
hiatal repair. |
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Keywords: | Hiatus hernia Laparoscopy Mesh Prosthesis Endoscopy |
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