Review Article
Volume 7 Issue 3 - 2020
A Reappraisal about the Use of Mesh for Hiatal Hernia Repair
AAlejandro Weber-Sanchez1* and Sofía Mateos-López2
1Department of Surgery, Hospital Ángeles Lomas, Anáhuac University, Huixquilucan, México
2Assistant Physician, Hospital Ángeles Lomas, Anáhuac University, Huixquilucan, México
*Corresponding Author: Alejandro Weber-Sanchez, Department of Surgery, Hospital Ángeles Lomas, Anáhuac University, Huixquilucan, México.
Received: January 14, 2020; Published: February 07, 2020




Abstract

Introduction: Hiatal hernia (HH) is a common anatomical disorder. Association with gastro esophageal reflux (GERD) is high, and HH act as a factor, accounting for the impairment and chronicity of GERD. Repair of HH and antireflux surgery are often done in the same surgical procedure by laparoscopy, being Nissen fundoplication the preferred anti-reflux surgery. Some key points to repair HH are extensive esophageal mobilization to bring down the gastroesophageal junction into the abdomen, complete sac dissection and tension-free closure of the hiatal crura. But tension-free closure of the hiatus is not always possible and if possible not guarantee that the tissue factor that induced hiatal defect, subside after repair, making recurrence possible.

HH repair has a high recurrence rate. 12% to 42% in some series, and up to 60% in others, which is unacceptable. To improve these bad results, prosthetic materials were introduced as an adjunct to the repair and have been reported to prevent recurrence. But occurrence of serious morbidity, in some patients, mainly strictures or erosions into the stomach or the esophagus, diminished the enthusiasm to use prosthetic materials. To date, there are no consensus about which cases need reinforcement, the best material, the shape of the mesh, or the proper technique of placement. It is advisable to think about HH not only as a simple hole, but as a complex problem in which tissue defect may be present, and learn from what we have known, mainly from inguinal hernia repair history.

Conclusion: Reinforcement the repaired hiatal area with mesh in some complex cases is under debate, but evidence indicate is useful to prevent recurrence. There is also no consensus about which is the best material or technique to place the mesh on the hiatus, but some technical points, as to avoid direct contact of the mesh with the esophagus and fix the mesh to the crura with suture to avoid displacement, make solid conclusions may be critical to avoid complications. More studies with emphasis on the technique and long follow-up are needed to make conclusions.

Keywords: Hiatal Hernia (HH); Gastro Esophageal Reflux (GERD); Mesh Reinforcement

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Citation: Alejandro Weber-Sanchez and Sofía Mateos-López. “A Reappraisal about the Use of Mesh for Hiatal Hernia Repair”. EC Gastroenterology and Digestive System 7.3 (2020): 01-10.

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