Complications of PTFE Mesh at the Diaphragmatic Hiatus

Abstract

Paraesophageal hernia repair has been associated with a recurrence rate of up to 42%. Thus, in the last decade, there has been increasing interest in the use of mesh reinforcement of the hiatal repair. Polytetrafluoroethylene (PTFE) is one of the materials that have been used for this purpose, as it is thought to induce minimal tissue reaction. We report two cases in which complications specific to the use of PTFE mesh in this location developed over time. In the first patient, a gastrectomy was required to remove a large PTFE mesh which had eroded into the esophagogastric junction and gastric cardia. The second patient experienced severe dysphagia resulting from a stricture caused by the implant, requiring removal of the mesh. Although such complications have only rarely been reported, the severity and consequences of these incidents, as reported in the literature and in light of our observations, suggest that an alternative to PTFE should be considered for crural reinforcement during paraesophageal hernia repair.

New Surgical Approach for Giant Paraesophageal Hernia Repair: Closure of the Esophageal Hiatus Anteriorly Using the Left Triangular Ligament

“…In addition, Gouvas et al reported significantly more cardiac and respiratory symptoms and a delayed esophageal transit time when comparing prosthetic reinforcement to simple crural repair [23]. More importantly, cases of intraluminal esophageal mesh erosion have been reported [6]. On balance, the use of nonabsorbable synthetic mesh should therefore be avoided in proximity to the distal esophagus [6].…”

“…More importantly, cases of intraluminal esophageal mesh erosion have been reported [6]. On balance, the use of nonabsorbable synthetic mesh should therefore be avoided in proximity to the distal esophagus [6]. …”

“…In an attempt to reduce the rate of recurrence, many surgeons further reinforce the repair with a prosthetic or biologic mesh. However, the use of mesh has not been prospectively validated and may lead to additional complications such as postoperative dysphagia, odynophagia, or even esophageal erosion [5,6]. In certain situations, not uncommonly, the posterior hiatoplasty is limited by the large size of the defect and impossibility of further approximation of the crural fibers.…”

Paraesophageal Hernia Repair

“…67,68) Furthermore, the safety of the use of the prosthesis is a matter of concern, because short-and long-term dysphagia as a result of reactive fibrosis around the esophagus, and erosion and fistulization of the foreign material to the viscera have been reported. 8,11,27,69) In order to minimize these adverse effects, a variety of materials have evolved. Different mesh shapes have also been appraised with regard to dysphagia and recurrence rates (Table 2, Fig 1).…”

Laparoscopic Antireflux Surgery: A Comparative Study of Nissen Fundoplication and Hiatoplasty With and Without Absorbable Biological Mesh

“…The use of biological mesh during hiatal hernia repair has been shown to decrease the recurrence rate of hernia lower than that obtained historically without the mesh [8]. The use of synthetic mesh is associated with complications such as oesophageal stricture, erosion, perforation, migration of mesh into oesophagus or stomach, and infections [9][10][11]. This has led to debate regarding the type of mesh material, size, shape, and fixation techniques.…”