Published online Oct 27, 2019. doi: 10.4240/wjgs.v11.i10.388
Peer-review started: March 22, 2019
First decision: August 2, 2019
Revised: September 30, 2019
Accepted: October 14, 2019
Article in press: October 14, 2019
Published online: October 27, 2019
Paraesophageal hernia (PEH) repair is one of the most challenging upper gastrointestinal operations. Its high rate of recurrence is due mostly to the low quality of the crura and size of the hiatal defect. In an attempt to diminish the recurrence rates, some clinical investigators have begun performing mesh-reinforced cruroplasty with nonabsorbable meshes like polypropylene or polytetrafluoroethylene. The main problem with these materials is the occurrence, in some patients, of serious mesh-related morbidities, such as erosions into the stomach and the esophagus, some of which necessitate subsequent esophagectomy or gastrectomy. Absorbable meshes can be synthetic or biological and were introduced in recent years for PEH repair with the intent of diminishing the recurrence rates observed after primary repair alone but, theoretically, without the risks of morbidities presented by the nonabsorbable meshes. The current role of absorbable meshes in PEH repair is still under debate, since there are few data regarding their long-term efficacy, particularly in terms of recurrence rates, morbidity, need for revision, and quality of life. In this opinion review, we analyze all the presently available evidence of reinforced cruroplasty for PEH repair using nonabsorbable meshes (synthetic or biological), focusing particularly on recurrence rates, mesh-related morbidity, and long-term quality of life.
Core tip: Paraesophageal hernia repair is one of the most challenging laparoscopic operations. This type of hernia is large and frequently associated with a short esophagus and poor quality of the diaphragmatic crura. Different types of mesh have been used to lower recurrence rates but many of them, mostly nonabsorbable, have been associated with significant morbidity (i.e., erosions). In this paper, we discuss the use of absorbable meshes (synthetic and biologic) in paraesophageal hernia repair.