Department of Surgery Hospital Clínico San Carlos, Madrid, Spain.
Dis Esophagus. 2019 Jul 1;32(7). doi: 10.1093/dote/doy131.
The purpose of the present study was to analyze the incidence, presentation, and treatment of mesh erosion into the esophagus or stomach after mesh hiatoplasty for primary or recurrent hiatal hernia. The study is a single-institution, retrospective cohort study. From November 2005 to December 2016, 122 patients consecutively underwent mesh hiatoplasty in our department, 91 during a primary surgery and 31 for a surgical revision. Follow-up was complete for 74%. Six patients of this series were evaluated for mesh erosion. In all cases, the mesh employed was a dual-type circular one. The mean time from surgery to erosion diagnosis was 42 months (median time 46 months, interquartile range 64 months). Three patients were asymptomatic, 1 had dysphagia, 1 had reflux recurrence, and 1 presented with mediastinal perforation. The absolute erosion rate was 4.9%. For patients under surveillance, the erosion rate was 6.6%, or 1 case every 48 patient-years of follow-up. The erosion rate after primary surgery was 3% or 1/86 patient-years of follow-up, and after surgery for recurrent hernia recurrence was 16% or 1/29 patient-years of follow-up. The mesh was left in place in 2 asymptomatic cases and endoscopically removed in 2 cases. Two patients submitted to surgical removal of the mesh, and only one needed a limited gastroesophageal junction resection for a conversion to a Roux-en-Y gastric bypass. The patient with esophageal perforation submitted to mesh removal, drainage, and an anterior partial fundoplication. There was no mortality. Mesh erosion after hiatoplasty presents with a high rate, especially when hiatoplasty is performed during revisional antireflux surgery. Most patients can be managed conservatively, and endoscopic removal should be considered a first-line therapy.
本研究的目的是分析原发性或复发性食管裂孔疝行网片修补术后网片侵蚀入食管或胃的发生率、表现和治疗方法。该研究为单中心回顾性队列研究。2005 年 11 月至 2016 年 12 月，我院连续有 122 例患者接受了网片修补术，其中 91 例为初次手术，31 例为手术翻修。74%的患者完成了随访。本系列中有 6 例患者评估为网片侵蚀。所有病例均使用双型圆形网片。从手术到侵蚀诊断的平均时间为 42 个月（中位数时间为 46 个月，四分位间距为 64 个月）。3 例患者无症状，1 例有吞咽困难，1 例有反流复发，1 例有纵隔穿孔。绝对侵蚀率为 4.9%。在接受监测的患者中，侵蚀率为 6.6%，即每 48 例患者-年随访中出现 1 例。初次手术后的侵蚀率为 3%，即每 86 例患者-年随访中出现 1 例；复发性疝修补术后的侵蚀率为 16%，即每 29 例患者-年随访中出现 1 例。2 例无症状患者保留了网片，2 例患者在内镜下切除了网片。2 例患者行网片切除术，其中 1 例因改行 Roux-en-Y 胃旁路术而行有限的胃食管连接部切除术。食管穿孔的患者行网片切除、引流和前部分胃底折叠术。无死亡病例。食管裂孔修补术后网片侵蚀发生率较高，尤其是在反流手术翻修时行食管裂孔修补术。大多数患者可以保守治疗，内镜下切除应作为一线治疗。
