title: Evaluation of DualMesh for repair of large hiatus hernia in a porcine model.
abstract: BACKGROUND
  Prosthetic fascial grafts are frequently used for augmentation of cruroplasty in large hiatus hernia repair to decrease the chances of recurrence. Potential complications such as intraluminal erosion may be related to the constant movement of mesh and diaphragm over the outer surface of the esophagus. This study aimed to evaluate DualMesh for repair of large hiatal defects in a porcine model.
  
  
  METHODS
  In this study, 18 Landrace x large white x Duroc crossbred pigs underwent either primary hiatal repair or tension-free prosthetic repair using DualMesh (80 x 50 mm or 80 x 100 mm). The animals were killed at 3 or 28 weeks for macroscopic and histologic evaluation of the hiatal region and gastroesophageal junction.
  
  
  RESULTS
  All grafts had become encapsulated at 28 weeks, and the majority had filmy adhesions only to the visceral aspect. In all models, the esophagus moved freely over the cut edge of the prosthesis. No signs of intraluminal erosion were documented. At histologic examination, significant ingrowth was noted on the porous side of the mesh, whereas no defined mesothelial layer was identified on the capsule of the nonporous side.
  
  
  CONCLUSIONS
  In this animal model of large hiatus hernia repair, DualMesh showed optimal characteristics in terms of host tissue incorporation on the porous side and absence of adhesions on the visceral side of the prosthesis. The absence of adhesions and intraluminal erosion in this study may provide reassurance to surgeons using mesh at the hiatus.
authors.affiliation: Department of Surgery, Royal North Shore Hospital, Level 2, Vindin House, St. Leonards, Sydney, NSW 2065, Australia. garetts@med.usyd.edu.au
authors.forename: G S
authors.initials: GS
authors.lastname: Smith
authors.forename: E J
authors.initials: EJ
authors.lastname: Hazebroek
authors.forename: R
authors.initials: R
authors.lastname: Eckstein
authors.forename: H
authors.initials: H
authors.lastname: Berry
authors.forename: W M
authors.initials: WM
authors.lastname: Smith
authors.forename: J R
authors.initials: JR
authors.lastname: Isaacson
authors.forename: G L
authors.initials: GL
authors.lastname: Falk
authors.forename: C J
authors.initials: CJ
authors.lastname: Martin
mesh_terms: D034861:Abdominal Wall / Q000473:pathology; D000818:Animals; D004195:Disease Models, Animal; D004943:Esophagogastric Junction / Q000473:pathology; D006551:Hernia, Hiatal / Q000601:surgery*; D013526:Surgical Mesh / Q000009:adverse effects; D013552:Swine; D013908:Thoracotomy / Q000009:adverse effects / Q000295:instrumentation; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology; D017211:Treatment Failure; D016896:Treatment Outcome