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THE SIZE OF HIATAL HERNIA THAT WILL REQUIRE USE OF MESH
Constantine T. Frantzides*1, Mark A. Carlson2,1, Alexander T. Frantzides1
1Surgery , Chicago Institute of Minimally Invasive Surgery , Skokie, IL; 2Surgery , University of Nebraska Medical Center, Omaha, NE
Introduction:
Our prospective randomized study (1991-2000) has shown that the use of mesh for the repair of large hiatal hernias would eliminate recurrences (previously published in Arch. Surg 2002). Subsequent studies by others reinforced this notion. The indications for mesh use, however, including the size of hiatal hernia defect, the type of mesh, and the placement technique remain controversial. The objective of this study was to define the size of hiatal defect that would require the use of mesh.
Methods:
Laparoscopic hiatal hernia repairs from 2001-2014 were identified and grouped according to size and method of repair. All repairs were performed using primary cruroplasty with interrupted non-absorbable sutures approximating the right and left bundles of the right crura. hernias larger than 5cm in diameter were reinforced using polytetrafluoroethylene (PTFE) mesh. A retrospective analysis was performed examining recurrence and perioperative morbidity and mortality.
Results:
A total of 1149 patients were identified and categorized into two groups. Group 1 consisting of 923 (80.3%) patients with defects smaller than 5cm, who underwent only simple cruroplasty, and Group 2 consisting of 226 (19.6%) patients with defects larger than 5cm, who underwent cruroplasty with onlay PTFE mesh reinforcement. All cases were performed laparoscopically. The duration of surgery was 1.6 +/-0.3 hours for Group 1 and 2.3 +/- 0.6 hours for Group 2 and the hospitalization was 1.5 +/- 0.2 days and 2.8 +/- 0.5 days respectively. The mean follow up was 3.6 (0.5-8.5) years. There were 16 (1.7%) hernia recurrences in Group 1, and 2 (0.8%) recurrences in Group 2. Three (0.3%) complications occurred in Group 1 consisting of pneumonia, bleeding, and esophageal perforation. Three (1.3%) complications occurred in Group 2 consisting of 3 pneumothoraces. There were no mesh erosions and no mortalities in either Group.
Conclusion:
The utilization of mesh for hiatal hernia repairs with defects of more than 5cm will result in reduction or elimination of recurrences. Smaller than 5cm hiatal defects may be repaired with simple cruroplasty, without the use of mesh.
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