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Background: Increasing use of mesh for hiatus repair during anti-reflux surgery has been reported. Re-operative intervention with previously placed mesh is technically more challenging. The aim of this study is to present a single Center experience with reoperative intervention in patients with previous mesh at hiatus and outcomes in this subset of patients.
Methods: After Institutional review board approval prospectively maintained database was retrospectively queried to identify patients who underwent re-operative intervention between 2003 to 2012 and had mesh placed at a previous hiatal hernia procedure. Patient charts were reviewed and variables collected included demographics, indications, operative details (initial and reoperative) and postoperative complications.
Results: Twenty-six patients met inclusion criteria and form the cohort for the study. There were 14 females with a mean age of 58.3 + 29.2 years. Synthetic mesh was placed in 15 (58%) patients, while the remaining 11 had bio-prosthetic mesh. Mean duration of re-operative intervention since the last surgery was 22 (1-52) months. Dysphagia (57%) was the most common presentation while 4 patients had mesh erosion. Recurrent hiatus hernia (2 to 7 cm) was noted in 16 (62%) patients. Nine patients (35%) underwent redo fundoplication, 8 (31%) were converted to Roux en Y gastrojejunostomy, 3 (12%) underwent distal esophagectomy with esophago-jejunostomy, 5 (19%) had subtotal esophagectomy with gastric pull-up and one patient underwent substernal gastric pull-up for esophageal bypass with interval esophagectomy. The mean operative time was 250 + 70.1 min, the median blood loss was 150 ml (50-1650 ml). Reoperative intervention was performed with laparoscopic approach in 50% (13/26) of the patients, laparoscopy converted to laparotomy in 12% (3/26) of the patients, laparotomy was performed in 34% (9/26) and thoracotomy was performed in 1 patient. There was no post-operative mortality. Major complications were noted in 6 patients. Mean ICU stay was 6 days and hospital stay was 14 days.
Conclusion: Reoperative intervention in patients with mesh at hiatus is associated with a high (>35 %) need for esophageal resection. More than half the patients also had a recurrent hiatal hernia. Caution is advised in liberal use of mesh for hiatoplasty.