title: Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement.
abstract: BACKGROUND
  The recurrence rate after laparoscopic repair of hiatal hernias with paraesophageal involvement (LRHP) is reported to be high. Mesh reinforcement has been proposed with the objective of solving this problem. This study aimed to compare the outcome of LRHP before and after the introduction of mesh reinforcement.
  
  
  METHODS
  Between 1992 and 2003, 56 consecutive patients received LRHP including posterior crurorrhaphy and additional fundoplication. Of these 56 patients, 17 underwent a mesh-reinforced hiatoplasty. Perioperative outcome was assessed retrospectively, and follow-up assessment was performed according to protocol including a barium contrast swallow.
  
  
  RESULTS
  The follow-up period averaged 52 +/- 31 months (range, 9-117 months). The recurrence rate for hiatal hernia without mesh reinforcement was 19% (7/36). No recurrence (0/16) was observed in patients with mesh reinforcement. The intraoperative complication rate was 9%, and the perioperative morbidity rate was 14%. There were neither mesh-related complications nor operation-related deaths.
  
  
  CONCLUSIONS
  Although challenging, LRPH is a successful procedure. The high recurrence rate reported in the literature can be reduced by additional mesh reinforcement.
authors.affiliation: Department of Surgery, Kantonsspital St. Gallen, St. Gallen, 9007, Switzerland.
authors.forename: B P
authors.initials: BP
authors.lastname: Müller-Stich
authors.forename: F
authors.initials: F
authors.lastname: Holzinger
authors.forename: T
authors.initials: T
authors.lastname: Kapp
authors.forename: C
authors.initials: C
authors.lastname: Klaiber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D055502:Secondary Prevention; D013526:Surgical Mesh; D016896:Treatment Outcome