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MANAGEMENT OF EROSION OF HIATAL MESH INTO THE GASTROESOPHAGEAL LUMEN
Aida Elisa Pérez Jiménez*, Maria Elia Pérez Aguirre, Adriana Ruano Campos, Pablo Talavera Eguizabal, Antonio J. Torres, Inmaculada Domínguez Serrano, Andrés Sánchez-Pernaute
General Surgery, Hospital Clinico San Carlos, Madrid, Spain
Introduction:
Mesh reinforcement of the hiatus is recommended for the treatment of large or recurrent hiatal hernia. However, concern exists about the possible complications, principally erosion into the esophagus, which can be related to a high rate of esophageal resection.
Aim:
Our aim is to analyze the presentation and management of mesh erosion into the gastroesophageal lumen.
Patients and method:
122 patients were consecutively submitted to mesh hernioplasty from November 2005 to December 2016, 91 as a primary hernia repair and 31 during a revisional surgery for hernia recurrence. Follow up was complete for 90 patients for a mean time of 38,4 months and a total followup of 288 patient-years. During this time, 7 patients were diagnosed of mesh erosion, 6 from our own series and one from other institution. In all cases the mesh was a dual-type circular one. In this subset, the initial hiatoplasty was for a primary hernia in 2 cases and for a recurrent hernia in the other 5.
Results:
Erosion was diagnosed at a mean time of 42 months form hiatoplasty (23 - 78). 3 cases were asymptomatic, 2 presented with dysphagia, one had symptoms of gastroesophageal reflux and one presented with esophageal perforation and mediastinitis. In 3 cases there was reflux recurrence, and in other 3 hernia recurrence. When considering only our Institution cases, absolute erosion rate was 4.9%; for patients under surveillance it was 6 out of 90 cases (6,6%), 1 case every 48 patient-years follow up. Erosion rate after primary hernia repair was 3%, or 1 case every 86 patient-years follow up; erosion rate after surgery for recurrent hernia was 16%, or 1 case every 29 patient-years of follow up.
The mesh was left in place in 2 asymptomatic patients, endoscopically removed in another 2, through an intragastric laparoscopy in 1 and surgically removed in the other 2, in one case during conversion of fundoplication into gastric bypass, and in the other case during the repair of a free esophagogastric perforation. All patients did well.
Conclusion:
Mesh erosion rate after hiatal hernioplasty is high, specially after surgery for recurrent hernia. Half of the patients can be managed conservatively. Surgery may be necessary for mesh removal, but there is usually no need of gastric or esophageal resection.
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