title: Hiatal hernia repair with mesh: a survey of SAGES members.
abstract: BACKGROUND
  Primary repair of large hiatal hernia is associated with a high recurrence rate. The use of mesh may reduce this recurrence rate. The indication for mesh use, the type of mesh to use, and the placement technique are controversial. A survey of surgeon practice was undertaken to obtain a better understanding of the controversies surrounding this clinical problem.
  
  
  METHODS
  A questionnaire on the technique and results of mesh hiatal herniorrhaphy was sent to 1,192 members of the Society of Gastrointestinal and Endoscopic Surgeons (SAGES).
  
  
  RESULTS
  There were 275 responses; 261 of these were analyzed. A total of 5,486 hiatal hernia repairs with mesh were reported; 77% and 23% were performed laparoscopically vs open, respectively. The most common indication for mesh usage was an increased size hiatal defect (46% of respondents). The most common mesh types were biomaterial (28%), polytetrafluoroethylene (25%), and polypropylene (21%). Suture anchorage was the most common fixation technique (56% of respondents). The findings showed a failure rate of 3%, a stricture rate of 0.2%, and an erosion rate of 0.3%. Biomaterial tended to be associated with failure, whereas nonabsorbable mesh tended to be associated with stricture and erosion.
  
  
  CONCLUSIONS
  The use of mesh during hiatal hernia repair resulted in a reported recurrence rate which appeared to be lower than that obtained historically without mesh. No one mesh type was clearly superior in terms of avoiding failure and complication.
authors.affiliation: Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Constantine T
authors.initials: CT
authors.lastname: Frantzides
authors.forename: Mark A
authors.initials: MA
authors.lastname: Carlson
authors.forename: Sofronis
authors.initials: S
authors.lastname: Loizides
authors.forename: Anastasia
authors.initials: A
authors.lastname: Papafili
authors.forename: Mihn
authors.initials: M
authors.lastname: Luu
authors.forename: Jacob
authors.initials: J
authors.lastname: Roberts
authors.forename: Tallal
authors.initials: T
authors.lastname: Zeni
authors.forename: Alexander
authors.initials: A
authors.lastname: Frantzides
mesh_terms: D005762:Gastroenterology; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D011474:Prosthesis Design; D019651:Plastic Surgery Procedures / Q000379:methods*; D055502:Secondary Prevention; D012955:Societies, Medical; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013536:Suture Techniques; D016896:Treatment Outcome; D014481:United States