title: Mesh-reinforced hiatal hernia repair: a review on the effect on postoperative dysphagia and recurrence.
abstract: OBJECTIVE
  The objective of the present study was to review the pertinent literature and analyze the evidence for and against the use of mesh for hiatal hernia repair, with a focus on the effects on recurrence and postoperative dysphagia.
  
  
  METHODS
  A literature search was performed between January 1990 and March 2010. Studies were considered for inclusion, provided (1) they comprised a series of at least 20 patients, (2) they documented a follow-up period of at least 6 months, (3) they reported on the outcome as expressed by hernia recurrence rates, and (4) they reported on type of mesh material, hiatal closure, and antireflux surgery.
  
  
  RESULTS
  Twenty-three articles enrolling a cumulative number of 1,446 patients fulfilled the inclusion criteria. Polypropylene meshes seem to be associated with low recurrence rates (0-22.7%, median 1.9%) and acceptable dysphagia rates (0-21.7%, median 3.9%). Higher dysphagia rates after polytetrafluoroethylene (PTFE) and expanded PTFE (ePTFE) mesh hiatoplasty have been recorded (15.5-34.3%). Even though the use of novel biologic implants for hiatal repair is still in its infancy, the existing results from clinical research are promising.
  
  
  CONCLUSIONS
  Polypropylene meshes seem to provide durable results with low dysphagia rates. Unacceptably high recurrence rates for PTFE/ePTFE meshes have been reported. Biologic implant engineering represents a promising field in hiatal hernia surgery.
authors.affiliation: Department of General and Visceral Surgery, Certified Reference Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany. stavros.antoniou@hotmail.com
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.forename: Oliver O
authors.initials: OO
authors.lastname: Koch
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.forename: Rudolph
authors.initials: R
authors.lastname: Pointner
authors.forename: Frank A
authors.initials: FA
authors.lastname: Granderath
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology*; D013505:Digestive System Surgical Procedures / Q000379:methods; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D011126:Polypropylenes; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D012008:Recurrence; D013526:Surgical Mesh
chemical_list: D011126:Polypropylenes; D011138:Polytetrafluoroethylene