Department of General Surgery, Affiliated Zhongda Hospital, Southeast University, Nanjing, 210009, China.
Hernia. 2019 Dec;23(6):1243-1252. doi: 10.1007/s10029-019-02011-w. Epub 2019 Jul 23.
Primary repair of large hiatal hernia is associated with a high recurrence rate, which has led to the use of mesh for crural repair. However, severe mesh-related complications, including esophageal or gastric erosion, have been observed.
In the present study, we made a thorough identification of all published reports on the esophageal or gastric mesh erosion or migration after hiatal hernia repair. The incidence, site, mesh type, latent interval, consequence and treatment methods of mesh erosion were summarized and analyzed.
A total of 50 cases of esophageal or gastric mesh erosion or migration after hiatal hernia repair were reported since 1998. A higher erosion rate was observed in recurrent hiatal hernia repair. The most common erosion site was esophagus (50%), followed by stomach (25%) and gastric-esophageal junction (GEJ) (23%). The most common mesh types reported in this series were PTEF and polypropylene. The duration from the hernia repair to the identification of erosion varied greatly, and 79% of the erosion occurred within 2 years after the hernia repair. Various treatment methods were reported, including endoscopic mesh retrieval (15.7%), laparoscopic mesh removal (11.8%), surgical mesh removal (19.6%); however, distal esophageal resection and gastric resection were reported in 19.6% and 5.9%, respectively. Some patients had to receive tube feeding.
The true incidence of mesh erosion after hiatal hernia repair may be higher than previously reported, and the erosion is more prone to occur after recurrent hiatal hernia repair. Mesh erosion can result in severe morbidity and sometimes require complex organ resection. Different kinds and shapes of prosthetic meshes can cause erosion; therefore, mesh should be used very selectively for hiatal hernia repair. The patient should be informed about the mesh placement and the possible mesh-related complications.
大型食管裂孔疝的初次修补与较高的复发率相关，这导致了对裂孔疝修补术中使用补片的应用。然而，严重的补片相关并发症，包括食管或胃侵蚀，已经被观察到。
本研究对所有已发表的关于食管裂孔疝修补术后食管或胃补片侵蚀或迁移的报告进行了全面的识别。总结和分析了补片侵蚀的发生率、部位、补片类型、潜伏期、后果和治疗方法。
自 1998 年以来，共报道了 50 例食管裂孔疝修补术后食管或胃补片侵蚀或迁移的病例。在复发性食管裂孔疝修补术中，侵蚀的发生率更高。最常见的侵蚀部位是食管（50%），其次是胃（25%）和胃食管交界处（GEJ）（23%）。本研究系列中报告的最常见的补片类型是 PTEF 和聚丙烯。从疝修补到侵蚀的识别时间差异很大，79%的侵蚀发生在疝修补后 2 年内。报告了各种治疗方法，包括内镜下补片取出（15.7%）、腹腔镜下补片取出（11.8%）、手术补片取出（19.6%）；然而，19.6%和 5.9%的患者分别需要进行食管下段切除术和胃切除术。一些患者需要接受管饲。
食管裂孔疝修补术后补片侵蚀的真实发生率可能高于以往报道，且在复发性食管裂孔疝修补术后更易发生。补片侵蚀可导致严重的发病率，有时需要进行复杂的器官切除术。不同类型和形状的假体补片可导致侵蚀；因此，在进行食管裂孔疝修补时应非常慎重地选择补片。应告知患者补片的放置位置和可能出现的补片相关并发症。
