Abstract
Background
Laparoscopy has become the standard surgical approach to both surgery for gastroesophageal reflux disease and large/paraesophageal hiatal hernia repair with excellent long-term results and high patient satisfaction. However, several studies have shown that laparoscopic hiatal hernia repair is associated with high recurrence rates. Therefore, some authors recommend the use of prosthetic meshes for either laparoscopic large hiatal hernia repair or laparoscopic antireflux surgery. The aim of this article was to review available studies regarding the evolution, different techniques, results, and future perspectives concerning the use of prosthetic materials for closure of the esophageal hiatus.
Methods
A search of electronic databases, including Medline and Embase, was performed to identify available articles regarding prosthetic hiatal closure for large hiatal or paraesophageal hernia repair and/or laparoscopic antireflux surgery. Techniques and results as well as recurrence rates and complications related to the use of prosthetics for hiatal closure were reviewed and compared. Additionally, recent experiences and recommendations of experienced experts in this field were collected.
Results
The results of 42 studies were analyzed in this review. Some techniques of mesh hiatal closure were evaluated; however, most authors prefer posterior mesh cruroplasty. The type and shape of hiatal meshes vary from small angular meshes to A-shaped, V-shaped, or complete circular meshes. The most frequently utilized materials are polypropylene, polytetrafluoroethylene, or dual meshes. All studies show a low rate of postoperative hernia recurrence, with no mortality and low morbidity. In particular, comparative studies including two prospective randomized trials comparing simple sutured hiatal closure to prosthetic hiatal closure show a significantly lower rate of postoperative hiatal hernia recurrence and/or intrathoracic wrap migration in patients who underwent prosthetic hiatal closure.
Conclusions
Laparoscopic large hiatal/paraesophageal hernia repair with prosthetic meshes as well as laparoscopic antireflux surgery with prosthetic hiatal closure are safe and effective procedures to prevent hiatal hernia recurrence and/or postoperative intrathoracic wrap migration, with low complication rates. The type of mesh, particularly the size and shape, is still controversial and is a matter for future research in this field.
Similar content being viewed by others
References
Amid PK (2004) Shrinkage: fake or fact? In: Schumpelick V, Nyhus LM (eds). Meshes: benefits and risks. Springer, Berlin, pp 198–206
Arendt T, Stuber E, Monig H, Folsch UR, Katsoulis S (2000) Dysphagia due to transmural migration of surgical material into the esophagus nine years after Nissen fundoplication. Gastrointest Endosc 51: 607–610
Athanasakis H, Tzortzinis A, Tsiaoussis J, Vassilakis JS, Xynos E (2001) Laparoscopic repair of paraesophageal hernia. Endoscopy 33: 590–594
Baladas HG, Smith GS, Richardson MA, Dempsey MB, Falk GL (2000) Esophagogastric fistula secondary to Teflon pledget: a rare complication following laparoscopic fundoplication. Dis Esophagus 13: 72–74
Basso N, De Leo A, Genco A, et al. (2000) 360° laparoscopic fundoplication with tension-free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease. Surg Endosc 14: 164–169
Behrns KE, Schlinkert RT (1996) Laparoscopic management of paraesophageal hernia: early results. J Laparoendosc Surg 6: 311–317
Carlson MA, Condon RE, Ludwig KA, Schulte WJ (1998) Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 187: 227–230
Carlson MA, Frantzides CT (2001) Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases. J Am Coll Surg 193: 428–439
Carlson MA, Richards CG, Frantzides CT (1999) Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy. Dig Surg 16: 407–410
Casabella F, Sinanan M, Horgan S, Pellegrini CA (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 171: 485–489
Casaccia M, Torelli P, Panaro F, Cavaliere D, Ventura A, Valente U (2002) Laparoscopic physiologic hiatoplasty for hiatal hernia: new composite “A” shaped mesh. Surg Endosc 16: 1441–1445
Champion JK, Rock D (2003) Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 17: 551–553
Coluccio G, Ponzio S, Ambu V, Tramontano R, Cuomo G (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: 341–345
Dally E, Falt GL (2004) Teflon pledget reinforced fundoplication causes symptomatic gastric and esophageal lumenal penetration. Am J Surg 187: 226–229
Díaz S, Brunt M, Klingensmith ME, Frisella PM, Soper NJ (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 7: 59–67
Edelman DS (1995) Laparoscopic paraesophageal hernia repair with mesh. Surg Laparosc Endosc 5: 32–37
Frantzides CT, Carlson MA (1997) Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorraphy. Surg Endosc 11: 769–771
Frantzides CT, Carlson MA (2001) Paraesophageal herniation. In: Baker RJ, Fischer JE (eds). Mastery of surgery, vol. 1. Lippincott Williams & Wilkins, Philadelphia, pp 721–736
Frantzides CT, Madan AK, Carlson MA, et al. (2002) A prospective, randomized trial of laparoscopic polytetraflouroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137: 649–653
Frantzides CT, Richards CG, Carlson MA (1999) Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene. Surg Endosc 13: 906–908
Granderath FA, Kamolz T, Schweiger UM, et al. (2003) Laparoscopic refundoplication with prosthetic hiatal closure for recurrent hiatal hernia after primary failed antireflux surgery. Arch Surg 138: 902–907
Granderath FA, Kamolz T, Schweiger UM, Pointner R (2004) Quality of life, patients satisfaction and surgical outcome after laparoscopic refundoplication: experiences with 100 laparoscopic redo-procedures. Surg Endosc Suppl 18: O212
Granderath FA, Schweiger UM, Kamolz T, et al. (2002) Laparoscopic antireflux surgery with routine mesh–hiatoplasty in the treatment of gastroesophageal reflux disease. J Gastrointest Surg 6: 347–353
Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R (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: 40–48
Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, et al. (2000) Laparoscopic repair of large type III hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg 190: 553–601
Hawasli A, Zonca S (1998) Laparoscopic repair of paraesophageal hiatal hernia. Am Surg 64: 703–710
Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias. Ann Surg 238: 391–400
Horgan S, Eubanks TR, Jacobsen G, Omelanczuk P, Pellegrini CA (1999) Repair of paraesophageal hernias. Am J Surg 177: 354–358
Hui TT, David T, Spyrou M, Phillips EH (2001) Mesh crural repair of large paraesophageal hiatal hernias. Am Surg 67: 1170–1174
Hunter JG, Smith CD, Branum GD, et al. (1999) Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg 230: 595–604
Huntington TR (1997) Laparoscopic mesh repair of the oesophageal hiatus. J Am Coll Surg 184: 399–401
Kamolz T, Granderath FA, Bammer T, Pasiut M, Pointner R (2002) Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prosthetic reinforcement of the hiatal crura. Surg Endosc 16: 572–577
Keidar A, Szold A (2003) Laparoscopic repair of paraesophageal hernia with selective use of mesh. Surg Laparosc Endosc 13: 149–154
Kemppainen E, Kiviluoto T (2000) Fatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia. Surg Endosc 14: 593
Kuster GG, Gilroy S (1993) Laparoscopic technique for repair of paraesophageal hiatal hernias. J Laparoendosc Surg 3: 331–338
Lambert AW, Huddart SN (2001) Mesh hiatal reinforcement in Nissen fundoplication. Pediatr Surg Int 17: 491–492
Leeder PC, Smith G, Dehn TC (2003) Laparoscopic management of large paraesophageal hiatal hernia. Surg Endosc 17: 1372–1375
Livingston CD, Lamar Jones H, Askew RE, Victor BE (2001) Laparoscopic hiatal hernia repair in patients with poor esophageal motility or paraesophageal herniation. Am Surg 67: 987–991
Medina L, Peetz M, Ratzer E, Fenoglio M (1998) Laparoscopic paraesophageal hernia repair. J Soc Laparoendosc Surg 2: 269–272
Meyer C, Bufffler A, Rohr S, Lima MC (2002) Le traitement laparoscopique des hernies hiatales de gran taille avec mise en place d’une prothese. A propos de dix cas. Ann Chir 127: 257–261
Morales Conde S, Ponce JF, Morales Mendez S (2002) Paraesophgeal hernia: technique and method of fixation of a mesh by laparoscopy. In Morales-Conde S (ed) Laparoscopic ventral hernia repair. Springer, New York
Oddsdottir M, Franco AL, Laycock WA, Waring JP, Hunter JG (1995) Laparoscopic repair of paraesophageal hernia. New access, old technique. Surg Endosc 9: 164–168
Oelschlager BK, Barreca M, Chang L, Pellegrini CA (2003) The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique. Am J Surg 186: 4–8
Paul MG, De Rosa RP, Petrucci PE, Palmer ML, Danovitch SH (1997) Laparoscopic tension-free repair of large paraesophageal hernias. Surg Endosc 11: 303–307
Perdikis G, Hinder RA, Filipi CJ, Walenz T, McBride PJ, Smith SL, Katada N, Klingler PJ (1997) Laparosopic paraesophageal hernia repair. Arch Surg 132: 586–590
Pitcher DE, Curet MJ, Vogt DM, Mason J, Zucker KA (1995) Successful repair of paraesophageal hernia. Arch Surg 130: 590–596
Ponce JF, Barriga R, Martin I, Morales Conde S, Morales S (1998) Prosthetic materials in incisional hernia. Experimental study. Cir Esp 63: 189–194
Ponsky J, Rosen M, Fanning A, Malm J (2003) Anterior gastropexy may reduce the recurrence after laparoscopic paraesophageal hernia repair. Surg Endosc 17: 1036–1041
Schulz HG (1998) Rezidivrate nach laparoskopischer Antirefluxoperation mit und ohne Prolenenetzplastik bei 318 Fällen—erste Ergebnisse. 7. Jahreskongress der Gesellschaft für Gastroenterologie Westfalen
Simpson B, Ricketts RR, Parker PM (1998) Prosthetic patch stabilization of crural repair in antireflux surgery in children. Am Surg 64: 67–70
Soper NJ, Dunnegan D (1999) Anatomic fundoplication failure after laparoscopic antireflux surgery. Ann Surg 229: 669–677
Trus TL, Bax T, Richardson WS, Branum GD, Mauren SJ, Swanstrom LL, Hunter JG (1997) Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1: 221–228
Van der Peet DL, Klinkerberg-Knol EC, Alonso A, Sietses C, Eijsbouts QAJ, Cuesta MA (2000) Laparoscopic treatment of large paraesophageal hernias. Surg Endosc 14: 1015–1018
Varga G, Cseke L, Kalmar K, Horvath OP (2004) Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias. Surg Endosc 18: 1051–1053
Voyles CR, Richardson JD, Bland KI, et al. (1981) Emergency abdominal wall reconstruction with polypropylene mesh: short-term benefits versus long-term complications. Ann Surg 194: 219–223
Wantz GE (1991) Atlas of hernia surgery. Raven Press, New York
Willekes CL, Edoga JK, Freeza EE (1997) Laparoscopic repair of paraesophageal hernia. Ann Surg 225: 31–38
Wu JS, Dunnegan DL, Soper NJ (1999) Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair. Surg Endosc 13: 497–502
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Granderath, F.A., Carlson, M.A., Champion, J.K. et al. Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc 20, 367–379 (2006). https://doi.org/10.1007/s00464-005-0467-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0467-0