title: Critical evaluation of a novel DualMesh repair for large hiatal hernias.
abstract: BACKGROUND
  The use of mesh for laparoscopic repair of large hiatal hernias may reduce recurrence rates in comparison to primary suture repair. However, there is a potential risk of mesh-related oesophageal complications due to prosthesis erosion. The aim of this study was to critically evaluate a novel mesh (DualMesh) repair of hiatal hernias with particular reference to intraluminal erosion.
  
  
  METHODS
  Medical records of 19 patients who underwent laparoscopic hiatal hernia repair with DualMesh reinforcement of the crural closure were reviewed from a prospectively collected database. Quality of life and symptom analysis was performed using quality of life in reflux and dyspepsia (QOLRAD) questionnaires pre- and postoperatively after 6 weeks, 6 months, 1 year and 2 years. Barium studies were performed on patients pre-operatively and two years postoperatively to assess hernia recurrence. After 2 years, oesophagogastric endoscopy was performed to assess signs of erosion.
  
  
  RESULTS
  Mean patient age was 70.5 years (range 49-85 years). Two years after hiatal hernia repair, there was significant improvement in quality-of-life scores (QOLRAD: p < 0.001). Follow-up barium studies performed at 31.3 months (range 29-40 months) after surgery showed moderate recurrent hernias (>4 cm) in 1/14 patients (7%). Endoscopies performed at 34.4 months (range 28-41 months) after surgery did not show any signs of prosthetic erosion.
  
  
  CONCLUSIONS
  Laparoscopic reinforcement of primary hiatal closure with DualMesh leads to a durable repair in patients with large hiatal hernias. Long-term endoscopic follow-up did not show any signs of mesh erosion after prosthetic reinforcement of the crural repair.
authors.affiliation: Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Level 2, Vindin House, St Leonards, Sydney, NSW, 2065, Australia. ejhazebroek@hotmail.com
authors.forename: E J
authors.initials: EJ
authors.lastname: Hazebroek
authors.forename: Y
authors.initials: Y
authors.lastname: Koak
authors.forename: H
authors.initials: H
authors.lastname: Berry
authors.forename: S
authors.initials: S
authors.lastname: Leibman
authors.forename: G S
authors.initials: GS
authors.lastname: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006551:Hernia, Hiatal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D011475:Prosthesis Failure; D011788:Quality of Life; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome