Hiatal hernia repair with mesh: a survey of SAGES members.
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.
Frantzides
Constantine T
CT
Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
Carlson
Mark A
MA
Loizides
Sofronis
S
Papafili
Anastasia
A
Luu
Mihn
M
Roberts
Jacob
J
Zeni
Tallal
T
Frantzides
Alexander
A
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