Prevention of mesh-related complications during hiatal hernia repair
EAES Academy. Grubnyk V. 07/05/22; 363183; P228
Assoc. Prof. Viktor Grubnyk
Contributions
Contributions
Abstract
The use of mesh implants for hiatal hernia repair can reduce the recurrence rate. At the same time, non-absorbable synthetic polypropylene and polytetrafluoroethylene mesh implants can cause erosion and migration into the lumen of esophagus and stomach. Management of these complications is difficult and may require redo surgery with increased risk of mortality and morbidity.
Purpose. To evaluate the effectiveness of surgical maneuvers during hiatal hernia repair to reduce the risk of mesh-related complications.
Methods. For the period from 2010 to present time in our clinic were used special methods to prevent mesh-related complications. Usually, we use small pieces (4.5 -6.5 cm.) of mesh with U-shape configuration. The experience of our clinic has shown that this configuration and size of the implant can reduce the number of complications associated with the mesh. For fixation of mesh, we used sutures, tackers. If possible, the self-fixating ProGrip mesh was used. The surgical maneuvers were as follows:
Firstly, we mobilize left lobe of liver to make the fixation of mesh easier. In patients with giant hernias, we don’t install the mesh between crura. Instead of this we perform relaxing incisions of diaphragm to make it possible to suture the crura. After this we cover the defects with mesh.
We place the remnants of the hernial sac, omentum flaps or lipomas between the mesh implant and the esophagus as a "spacer".
Finally, we perform the fundoplication in such a way as to avoid contact between the edges of the mesh and the esophagus.
Results:
For the period from 2000 to 2020 in our clinic 2490 patients with GERD and HH underwent antireflux surgery, 1200 patients had large HHs. In 692 cases of HH repair mesh implants were used. Mesh related complications were detected in 12 patients (1.73%). Redo operations were performed in 12 patients. In 7 patients, the mesh was removed completely. In 1 patient, the mesh was removed and the mediastinum was drained (leakage stopped after 4 weeks). In 3 patients the migration of nitinol mesh into the esophageal lumen occurred. It was possible to remove it endoscopically with the subsequent installation of special stents. Good results were obtained in 10 of 12 patients after reoperation. Dysphagia was observed in 2 patients after reoperation, it required repeated balloon dilation and stent placement in one case.
Conclusion:
We believe that the proposed surgical maneuvers are effective in preventing of mesh erosion and migration and can reduce the number of redo operations.
Purpose. To evaluate the effectiveness of surgical maneuvers during hiatal hernia repair to reduce the risk of mesh-related complications.
Methods. For the period from 2010 to present time in our clinic were used special methods to prevent mesh-related complications. Usually, we use small pieces (4.5 -6.5 cm.) of mesh with U-shape configuration. The experience of our clinic has shown that this configuration and size of the implant can reduce the number of complications associated with the mesh. For fixation of mesh, we used sutures, tackers. If possible, the self-fixating ProGrip mesh was used. The surgical maneuvers were as follows:
Firstly, we mobilize left lobe of liver to make the fixation of mesh easier. In patients with giant hernias, we don’t install the mesh between crura. Instead of this we perform relaxing incisions of diaphragm to make it possible to suture the crura. After this we cover the defects with mesh.
We place the remnants of the hernial sac, omentum flaps or lipomas between the mesh implant and the esophagus as a "spacer".
Finally, we perform the fundoplication in such a way as to avoid contact between the edges of the mesh and the esophagus.
Results:
For the period from 2000 to 2020 in our clinic 2490 patients with GERD and HH underwent antireflux surgery, 1200 patients had large HHs. In 692 cases of HH repair mesh implants were used. Mesh related complications were detected in 12 patients (1.73%). Redo operations were performed in 12 patients. In 7 patients, the mesh was removed completely. In 1 patient, the mesh was removed and the mediastinum was drained (leakage stopped after 4 weeks). In 3 patients the migration of nitinol mesh into the esophageal lumen occurred. It was possible to remove it endoscopically with the subsequent installation of special stents. Good results were obtained in 10 of 12 patients after reoperation. Dysphagia was observed in 2 patients after reoperation, it required repeated balloon dilation and stent placement in one case.
Conclusion:
We believe that the proposed surgical maneuvers are effective in preventing of mesh erosion and migration and can reduce the number of redo operations.
The use of mesh implants for hiatal hernia repair can reduce the recurrence rate. At the same time, non-absorbable synthetic polypropylene and polytetrafluoroethylene mesh implants can cause erosion and migration into the lumen of esophagus and stomach. Management of these complications is difficult and may require redo surgery with increased risk of mortality and morbidity.
Purpose. To evaluate the effectiveness of surgical maneuvers during hiatal hernia repair to reduce the risk of mesh-related complications.
Methods. For the period from 2010 to present time in our clinic were used special methods to prevent mesh-related complications. Usually, we use small pieces (4.5 -6.5 cm.) of mesh with U-shape configuration. The experience of our clinic has shown that this configuration and size of the implant can reduce the number of complications associated with the mesh. For fixation of mesh, we used sutures, tackers. If possible, the self-fixating ProGrip mesh was used. The surgical maneuvers were as follows:
Firstly, we mobilize left lobe of liver to make the fixation of mesh easier. In patients with giant hernias, we don’t install the mesh between crura. Instead of this we perform relaxing incisions of diaphragm to make it possible to suture the crura. After this we cover the defects with mesh.
We place the remnants of the hernial sac, omentum flaps or lipomas between the mesh implant and the esophagus as a "spacer".
Finally, we perform the fundoplication in such a way as to avoid contact between the edges of the mesh and the esophagus.
Results:
For the period from 2000 to 2020 in our clinic 2490 patients with GERD and HH underwent antireflux surgery, 1200 patients had large HHs. In 692 cases of HH repair mesh implants were used. Mesh related complications were detected in 12 patients (1.73%). Redo operations were performed in 12 patients. In 7 patients, the mesh was removed completely. In 1 patient, the mesh was removed and the mediastinum was drained (leakage stopped after 4 weeks). In 3 patients the migration of nitinol mesh into the esophageal lumen occurred. It was possible to remove it endoscopically with the subsequent installation of special stents. Good results were obtained in 10 of 12 patients after reoperation. Dysphagia was observed in 2 patients after reoperation, it required repeated balloon dilation and stent placement in one case.
Conclusion:
We believe that the proposed surgical maneuvers are effective in preventing of mesh erosion and migration and can reduce the number of redo operations.
Purpose. To evaluate the effectiveness of surgical maneuvers during hiatal hernia repair to reduce the risk of mesh-related complications.
Methods. For the period from 2010 to present time in our clinic were used special methods to prevent mesh-related complications. Usually, we use small pieces (4.5 -6.5 cm.) of mesh with U-shape configuration. The experience of our clinic has shown that this configuration and size of the implant can reduce the number of complications associated with the mesh. For fixation of mesh, we used sutures, tackers. If possible, the self-fixating ProGrip mesh was used. The surgical maneuvers were as follows:
Firstly, we mobilize left lobe of liver to make the fixation of mesh easier. In patients with giant hernias, we don’t install the mesh between crura. Instead of this we perform relaxing incisions of diaphragm to make it possible to suture the crura. After this we cover the defects with mesh.
We place the remnants of the hernial sac, omentum flaps or lipomas between the mesh implant and the esophagus as a "spacer".
Finally, we perform the fundoplication in such a way as to avoid contact between the edges of the mesh and the esophagus.
Results:
For the period from 2000 to 2020 in our clinic 2490 patients with GERD and HH underwent antireflux surgery, 1200 patients had large HHs. In 692 cases of HH repair mesh implants were used. Mesh related complications were detected in 12 patients (1.73%). Redo operations were performed in 12 patients. In 7 patients, the mesh was removed completely. In 1 patient, the mesh was removed and the mediastinum was drained (leakage stopped after 4 weeks). In 3 patients the migration of nitinol mesh into the esophageal lumen occurred. It was possible to remove it endoscopically with the subsequent installation of special stents. Good results were obtained in 10 of 12 patients after reoperation. Dysphagia was observed in 2 patients after reoperation, it required repeated balloon dilation and stent placement in one case.
Conclusion:
We believe that the proposed surgical maneuvers are effective in preventing of mesh erosion and migration and can reduce the number of redo operations.
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