title: The safety of biologic mesh for laparoscopic repair of large, complicated hiatal hernia.
abstract: BACKGROUND
  Biologic mesh is widely used for repair of large, complicated hiatal hernias. Recently, there have been reports of complications after its implantation. We studied the course of a large group of patients who had undergone hiatal hernia repair with use of biologic mesh to determine the rate of immediate and late complications related to its use.
  
  
  METHODS
  All patients who had biologic mesh placed at the hiatus and who had been followed for at least 1 year were included. Perioperative data were reviewed, and a questionnaire was administered, designed to identify symptoms of gastroesophageal reflux, other symptoms such as dysphagia, and all other operative or endoscopic interventions that occurred after mesh implantation. In addition, postoperative radiologic and endoscopic studies were reviewed to assess signs of complications related to use of mesh.
  
  
  RESULTS
  There were 126 patients eligible for the study. We were able to contact 73 of these patients, at median follow-up of 45 months. No mesh-related complications were found. The frequency and severity of heartburn, regurgitation, and dysphagia improved significantly compared with preoperative values, and 89% of the patients reported good to excellent results in terms of overall satisfaction. Six patients recorded worsening of dysphagia postoperatively, but after careful work-up and review of each individual case, no case seemed to be directly related to the mesh. No erosions, strictures, or other complications directly related to use of mesh were found. One patient required reoperation due to hiatal hernia recurrence with gastroesophageal reflux disease (GERD) symptoms.
  
  
  CONCLUSIONS
  Use of biologic mesh for laparoscopic repair of large, complicated hiatal hernias appears safe. There were no major complications related to the mesh, and overall satisfaction with the operation was very good.
authors.affiliation: Department of Surgery, University of Washington, Box 356410, 1959 NE Pacific Street, Seattle, WA 98115, USA. ewassena@uw.edu
authors.forename: Eelco B
authors.initials: EB
authors.lastname: Wassenaar
authors.forename: Fernando
authors.initials: F
authors.lastname: Mier
authors.forename: Huseyin
authors.initials: H
authors.lastname: Sinan
authors.forename: Rebecca P
authors.initials: RP
authors.lastname: Petersen
authors.forename: A Valeria
authors.initials: AV
authors.lastname: Martin
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Pellegrini
authors.forename: Brant K
authors.initials: BK
authors.lastname: Oelschlager
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013526:Surgical Mesh / Q000009:adverse effects*
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