Calvary Bruce Public Hospital, Bruce, ACT, Australia.
Austin Hospital and Heidelberg Repatriation Hospitals, 145 Studley Road, PO Box 5555, Heidelberg, VIC, 3084, Australia.
Surg Endosc. 2020 Oct;34(10):4257-4280. doi: 10.1007/s00464-020-07723-0. Epub 2020 Jun 18.
Paraoesophageal hernias (PEH) have a high recurrence rate, prompting surgeons to consider the use of mesh reinforcement of the hiatus. The risks and benefits of mesh augmentation in PEH repair are debated. Mesh-related complications including migration and erosion are considered in this publication.
A systematic literature review of articles published between 1970 and 2019 in Medline, OVID, Embase, and Springer database was conducted, identifying case reports, case series and observational studies of PEH repair reporting mesh-related complications.
Thirty-five case reports/series of 74 patients and 20 observational studies reporting 75 of 4200 patients with mesh complications have been included. The incidence of mesh-related erosions in this study is 0.035%. PTFE, ePTFE, composite and synthetic meshes were frequently associated with mesh erosion requiring intervention. Complete erosions are often managed endoscopically while partial erosions may require surgery and resection of the oesophagus and/or stomach.
Mesh-related complication is rare with dysphagia a common presenting feature. Mesh erosion is associated with synthetic mesh more frequently in the reported literature. A mesh registry with long-term longitudinal data would help in understanding the true incidence of mesh-related complications.
食管裂孔疝（PEH）的复发率较高，促使外科医生考虑使用网片加强裂孔。PEH 修补术中使用网片增强的风险和益处存在争议。本文考虑了与网片相关的并发症，包括迁移和侵蚀。
对 1970 年至 2019 年间在 Medline、OVID、Embase 和 Springer 数据库中发表的文章进行了系统的文献回顾，确定了报告与网片相关并发症的 PEH 修复的病例报告、病例系列和观察性研究。
本研究共纳入 35 例病例报告/系列，共 74 例患者和 20 项观察性研究，共报告了 75 例 4200 例患者中出现网片相关并发症。本研究中，网片相关侵蚀的发生率为 0.035%。PTFE、ePTFE、复合和合成网片常与需要干预的网片侵蚀相关。完全侵蚀通常经内镜治疗，而部分侵蚀可能需要手术切除食管和/或胃。
与网片相关的并发症罕见，吞咽困难是常见的表现特征。在报告的文献中，与合成网片相关的网片侵蚀更为常见。一个具有长期纵向数据的网片登记处将有助于了解网片相关并发症的真实发生率。
