Repair of large paraesophageal hiatus hernia with polypropylene prosthesis

ABSTRACT

Posterior Cruroplasty repair of a large paraesophageal hiatus has a higher than desirable rate of recurrence attributable to the inexorable cyclic negative intrathoracic pressure of respiration and positive intrabdominal pressure produced by straining, physical exertion and coughing. To reduce the risk of recurrence, we have used posterior cruroplasty reinforced with an onlay polypropylene mesh prosthesis. Thirty consecutive patients with paraesophageal hiatus hernia had transabdominal posterior cruroplasty and onlay polypropylene mesh prosthesis applied to the crura and adjacent diaphragm to reinforce the hiatal defect with Nissen fundoplication to control associated reflux which was present in 80% of the patients. As regards to pre-and postoperative clinical manifestations, contrast radiography and upper gastrointestinal endoscopy, the results of the operation were excellent in 22 patients [73%], good in 6 patients [7%] Postoperative course was sound in most patients [23 from 30 patients]. After a period of follow up [from 18 to 48 months] there was neither cases of recurrence, nor complications related to the mesh. We conclude that mesh reinforcement of the esophageal hiatus hernia repair is effective, have a low clinical recurrence rate, and devoid of any complications related to the used polypropylene mesh. Concomitant antireflux procedure [we used Nissen fundoplication] is recommended in all operations for paraesophageal hiatus hernia especially if reflux can not be excluded before operation, or retroesophageal dissection is needed