Mesh-related complications in paraoesophageal repair: a systematic review
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and Other Interventional Techniques
REVIEW ARTICLE
Mesh‑related complications in paraoesophageal repair: a systematic review Calista Spiro1,2 · Natalie Quarmby1 · Siva Gananadha1,3 Received: 11 February 2020 / Accepted: 9 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Paraoesophageal hernias (PEH) have a high recurrence rate, prompting surgeons to consider the use of mesh reinforcement of the hiatus. The risks and benefits of mesh augmentation in PEH repair are debated. Mesh-related complications including migration and erosion are considered in this publication. Design A systematic literature review of articles published between 1970 and 2019 in Medline, OVID, Embase, and Springer database was conducted, identifying case reports, case series and observational studies of PEH repair reporting mesh-related complications. Results Thirty-five case reports/series of 74 patients and 20 observational studies reporting 75 of 4200 patients with mesh complications have been included. The incidence of mesh-related erosions in this study is 0.035%. PTFE, ePTFE, composite and synthetic meshes were frequently associated with mesh erosion requiring intervention. Complete erosions are often managed endoscopically while partial erosions may require surgery and resection of the oesophagus and/or stomach. Conclusions Mesh-related complication is rare with dysphagia a common presenting feature. Mesh erosion is associated with synthetic mesh more frequently in the reported literature. A mesh registry with long-term longitudinal data would help in understanding the true incidence of mesh-related complications. Keywords Laparoscopic paraoesophageal hernia repair · Anti-reflux surgery · Hiatal hernia repair · Mesh erosion · Biologic mesh · Synthetic mesh Paraoesophageal hernias (PEH) are a small subset of hiatal hernias. Patients present with symptoms of gastroesophaeal reflux disease or mechanical symptoms with risks of gastric volvulus and incarceration. As there are no effective longterm medical treatment options these hernias are repaired surgically. Traditionally repaired via transthoracic or open transabdominal access, PEH are now repaired laparoscopically in experienced surgical units. These large hernias are Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-07723-0) contains supplementary material, which is available to authorized users. * Calista Spiro [email protected] 1
Calvary Bruce Public Hospital, Bruce, ACT, Australia
2
Austin Hospital and Heidelberg Repatriation Hospitals, 145 Studley Road, PO Box 5555, Heidelberg, VIC 3084, Australia
3
The Canberra Hospital, Garran, ACT, Australia
associated with high recurrence rates and therefore surgeons have used mesh in attempt to reduce the recurrence rates. However, randomized control trials have demonstrated variable rates of recurrence of hiatal hernias in the long term [1–8]. Decisions on the type of mesh used may be based on personal ex
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