INTRODUCTION

In recent years prosthetic cruroplasty with PTFE has been advocated as the optimal way to reduce hernia recurrence when repairing large hiatal hernia. However, we have found in our series a significant incidence of rejection and mesh erosion.

MATERIALS AND METHODS

Standard, tension-free ePTFE hiatal hernia repair was performed in 15 patients with large hiatal hernia. Three of these patients subsequently went on to develop complications with the mesh. Here we present these cases: 2 females and 1 male aged 84, 66 and 69 years, respectively. Each underwent prosthetic hiatal hernia repair using dual goretex mesh. After 7, 12, and 34 months each of the cases presented with dysphagia.

RESULTS

In all three of these cases initial endoscopy revealed narrowing at the lower end of the oesophagus, with inflammatory changes and erosion. In two of the cases, the mesh was noted to have eroded into the distal oesophagus, and in the third case relaparoscopy showed a peri-oesophageal collection including the mesh surrounded with fibrosis. Each of the complications was managed using minimally invasive techniques. In one instance the eroded mesh was removed by endoscopy without further complication. While in the second, due to the patient's age and comorbidities the eroded mesh was left in-situ and a covering stent was endoscopically sited. In the case of the peri-oesophageal collection, this was drained laparoscopically and the mesh was removed, with the patient making an excellent recovery. In each instance the patient's dysphagia was corrected and there was no recurrence of the hiatus hernia.

CONCLUSIONS

We conclude by acknowledging that in spite of the fact that Gore-Tex (ePTFE) is currently being recommended as one of the choice materials for the prosthetic reconstruction of the hiatus. Our experience suggests that it should be used with great caution in the peri-oesophageal region.