Is a circular polypropylene mesh appropriate for application at the esophageal hiatus? Results from an experimental study in a porcine model.
BACKGROUND
Mesh reinforcement in hiatal hernia surgery is debated. Randomized controlled trials have shown that recurrences may be reduced, but there is also the fear of mesh-related complications. Experimental studies on the characteristics of specific mesh types with regard to the risk of such complications are rare. The current study aimed to investigate the properties of a circular heavy-weight polypropylene mesh in terms of stenosis, migration, erosions, and adhesions in a porcine model.


METHODS
A 55 x 55-mm heavy-weight polypropylene mesh with a 16.5-mm eccentric hole for the esophagus corresponding to a calculated mesh area of 2811 mm(2) and a hole area of 214 mm(2) were implanted in nine German Landrace pigs. Six weeks later, the meshes were explanted and investigated for size, shrinkage, migration and adhesions.


RESULTS
The total mesh area shrank to a mean of 2,040 +/- 178 mm(2) (p < 0.001), and the hole for the esophagus showed a trend toward an increase to 239 +/- 38 mm(2) (p = 0.108). In not a single location did the mesh overhang the hiatal margin. The mean distance of retraction from the hiatal margin was 4.3 +/- 2.8 mm. Therefore, no stenoses, migrations, or erosions occurred.


CONCLUSIONS
A circular heavy-weight polypropylene mesh seems to be appropriate for the application at the esophageal hiatus in terms of safety and stability. This means that it is characterized by a position-stable centered fixation around the esophagus without a tendency toward stenosis, migration, or erosion.
Müller-Stich
Beat P
BP
Department of General, Abdominal, and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany. beat.mueller@med.uni-heidelberg.de
Mehrabi
Arianeb
A
Kenngott
Hannes G
HG
Fonouni
Hamidreza
H
Reiter
Michael A
MA
Kuttymoratov
Gani
G
Nickel
Felix
F
Linke
Georg R
GR
Wolf
Ivo
I
Köninger
Jörg
J
Gutt
Carsten N
CN
D000818:Animals; D004195:Disease Models, Animal; D004947:Esophagus / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D011126:Polypropylenes; D011183:Postoperative Complications / Q000517:prevention & control; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D013526:Surgical Mesh; D013552:Swine; D016896:Treatment Outcome
D011126:Polypropylenes