Over three years results of hiatal hernia repair with mesh in a single institution

Introduction: The standard technique for hiatal hernia repair (HHR) is controversial and it remain debated how to treat large hiatal hernia (HH) during bariatric procedures in obese population, which have a per se negative impact on recurrence rate. The aim of the present paper was to report the long-term results of a single institution series of HHR with mesh in obese patients, evaluating the safety profile of the absorbable mesh. Materials and methods: 90 obese (mean BMI 43,4 ± 5,65 kg/m2) patients (18 male; 72 female) treated with HHR (mean defect size 6 ± 2 cm2) with mesh (BIO-A U shaped -W.L. Gore & Associates, Inc. Flagstaff,AZ) were evaluated after a mean follow-up of 39 ± 5months. In the 64.4% of these the HH diagnosis was made pre-operatively and eight patients were submitted to revisional bariatric surgery. The end-points evaluated were dysphagia rate (%), post-operative complications mesh related (> 30 days), GERD symptoms control (questionnaire Rome III) and endoscopic findings, recurrence (%-clinical and/or radiological). The HHR reinforced with mesh was performed with the following concomitant laparoscopic bariatric procedures: 79 sleeve gastrectomy (LSG), 7 re- LSG, 4 standard gastric bypass (GBP). Results: No complications mesh related was registered post-operatively (> 30 days) and after long-term follow-up. 51 of 64 (79.6%) of patients affected by pre-operative GERD solved completely the problem without need of PPI therapy. The remnant 13 presented the followed symptoms: EPS (epigastric pain syndrome) (5 patients), nausea and vomit (less then 5 monthly epysode - 6 patients), atypical GERD symptoms (2 patients). Only one patient was converted to GBP (1.05%) 26 months after the primary LSG. Transient dysphagia was reported in 5%. Regarding the recurrence we observed 4 cases (4.4%): 3 radiological recurrence and 1 clinical and radiological. Conclusions: Our results supports the use of mesh for the treatment of HH > 4 cm2 in obese patients during bariatric procedure showing excellent recurrence rate results (4.4%) and good GERD symptoms control.