Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 7, 2013; 19(33): 5528-5533
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5528
Dual-sided composite mesh repair of hiatal hernia: Our experience and a review of the Chinese literature
Wei Zhang, Wei Tang, Cheng-Xiang Shan, Sheng Liu, Zhi-Guo Jiang, Dao-Zhen Jiang, Xiang-Min Zheng, Ming Qiu
Wei Zhang, Cheng-Xiang Shan, Sheng Liu, Zhi-Guo Jiang, Dao-Zhen Jiang, Xiang-Min Zheng, Ming Qiu, Department of General Surgery of Changzheng Hospital affiliated to the Second Military Medical University, Shanghai 200003, China
Wei Tang, Department of Surgery, University of Tokyo Hospital, Tokyo 113-8655, Japan
Author contributions: Zhang W and Shan CX contributed equally to this work; Zhang W, Tang W and Qiu M designed the research; Zhang W, Shan CX, Liu S, Jiang ZG and Qiu M performed the research; Jiang DG and Zheng XM performed the statistical analysis; Zhang W and Shan CX wrote the paper.
Correspondence to: Ming Qiu, Professor, Department of General Surgery of Changzheng Hospital affiliated to the Second Military Medical University, No. 415 Fengyang Road, Shanghai 200003, China. qiuming2006@yahoo.cn
Telephone: +86-21-81885801 Fax: +86-21-63520020
Received: February 21, 2013
Revised: June 6, 2013
Accepted: July 4, 2013
Published online: September 7, 2013
Abstract

AIM: To summarize our experience in the application of Crurasoft® for antireflux surgery and hiatal hernia (HH) repair and to introduce the work of Chinese doctors on this topic.

METHODS: Twenty-one patients underwent HH repair with Crurasoft® reinforcement. Gastroesophageal reflux disease (GERD) and HH-related symptoms including heartburn, regurgitation, chest pain, dysphagia, and abdominal pain were evaluated preoperatively and 6 mo postoperatively. A patient survey was conducted by phone by one of the authors. Patients were asked about “recurrent reflux or heartburn” and “dysphagia”. An internet-based Chinese literature search in this field was also performed. Data extracted from each study included: number of patients treated, hernia size, hiatorrhaphy, antireflux surgery, follow-up period, recurrence rate, and complications (especially dysphagia).

RESULTS: There were 8 type I, 10 type II and 3 type III HHs in this group. Mean operative time was 119.29 min (range 80-175 min). Intraoperatively, length and width of the hiatal orifice were measured, (4.33 ± 0.84 and 2.85 ± 0.85 cm, respectively). Thirteen and eight Nissen and Toupet fundoplications were performed, respectively. The intraoperative complication rate was 9.52%. Despite dysphagia, GERD-related symptoms improved significantly compared with those before surgery. The recurrence rate was 0% during the 6-mo follow-up period, and long-term follow-up disclosed a recurrence rate of 4.76% with a mean period of 16.28 mo. Eight patients developed new-onset dysphagia. The Chinese literature review identified 12 papers with 213 patients. The overall recurrence rate was 1.88%. There was no esophageal erosion and the rate of dysphagia ranged from 0% to 24%.

CONCLUSION: The use of Crurasoft® mesh for HH repair results in satisfactory symptom control with a low recurrence rate. Postoperative dysphagia continues to be an issue, and requires more research to reduce its incidence.

Keywords: Hiatal hernia, Gastroesophageal reflux disease, Anti-reflux surgery, Mesh, Prosthetic

Core tip: With a focus on the mesh fixation technique, the application of Crurasoft® for antireflux surgery and hiatal hernia repair achieved satisfactory outcome. The recurrence rate was 0% during the 6-mo follow-up period, and long-term follow-up disclosed a recurrence rate of 4.76% with a mean period of 16.28 mo. Eight patients developed new-onset dysphagia and this gradually resolved without difficulty in swallowing solid food in 6 patients. The Chinese literature review identified 12 papers with 213 patients. The overall recurrence rate was 1.88%. There was no esophageal erosion and the rate of dysphagia ranged from 0% to 24%.