Role of Mesh in the Reinforcement of the Primary Repair of Large Hiatal Hernia

Abstract

he incidence of hiatal hernias increases with age. Approximately 55%-60% of individuals over the age of 50 have a hiatal hernia. However, only about 9% have symptoms, and it depends on the type and competency of the lower esophageal sphincter. The vast majority of these hernias are type I sliding hiatal hernias. Type II, paraesophageal hernias, only make up about 5% of hiatal hernias where the LES remains stationary, but the stomach protrudes above the diaphragm. There is also an increased prevalence in women, which could be attributed to increased intraabdominal pressure during pregnancy. Hiatal hernias are most common in Western Europe and North America and are rare in rural Africa. Hiatal hernias may be congenital or acquired. There is an increased prevalence in older people. It is believed that muscle weakness with loss of flexibility and elasticity with age predisposes to the development of a hiatal hernia. This may cause the upper part of the stomach to not return to its natural position below the diaphragm during swallowing. Other predisposing factors have been identified, such as elevated intraabdominal pressure. This typically is a result of obesity, pregnancy, chronic constipation, and chronic obstructive pulmonary disease (COPD). Trauma, age, previous surgeries, and genetics can also play a role in the development of a hiatal hernia. The typical presentation leading to an evaluation for a hiatal hernia is gastroesophageal reflux disease (GERD). Patients typically complain of heartburn and sometimes regurgitation. While heartburn is the most common complaint, some patients will present with extra-esophageal symptoms such as a chronic cough or asthma. The presentation of regurgitation or extra-esophageal symptoms typically is a sign of disease progression. Dysphagia is another problem seen with advanced disease. Management for hiatal hernias depends on the type of hernia and severity of symptoms. Patients who have more than 8 years of life expectancy and are in need of lifelong therapy because of a mechanically defective LES, surgical therapy may be considered the treatment of choice. The use of Phasix ST mesh to reinforce crural repair for large hiatus hernias is safe, is effective in the short-term follow-up, and is associated to improved quality of life. In our study, an objective observational study was made regarding post operative short term mesh related complications possible to develop in patients underwent hiatal repair of large hiatal hernia with mesh rienforcement. The study was conducted over 15 patients who had double face prolene mesh placed onlay over the repair of the crura of the hiatal defect. Laparoscopic large hiatal/paraesophageal hernia repair with