title: Dual-sided composite mesh repair of hiatal hernia: our experience and a review of the Chinese literature.
abstract: OBJECTIVE
  To summarize our experience in the application of Crurasoft® for antireflux surgery and hiatal hernia (HH) repair and to introduce the work of Chinese doctors on this topic.
  
  
  METHODS
  Twenty-one patients underwent HH repair with Crurasoft® reinforcement. Gastroesophageal reflux disease (GERD) and HH-related symptoms including heartburn, regurgitation, chest pain, dysphagia, and abdominal pain were evaluated preoperatively and 6 mo postoperatively. A patient survey was conducted by phone by one of the authors. Patients were asked about "recurrent reflux or heartburn" and "dysphagia". An internet-based Chinese literature search in this field was also performed. Data extracted from each study included: number of patients treated, hernia size, hiatorrhaphy, antireflux surgery, follow-up period, recurrence rate, and complications (especially dysphagia).
  
  
  RESULTS
  There were 8 type I, 10 type II and 3 type III HHs in this group. Mean operative time was 119.29 min (range 80-175 min). Intraoperatively, length and width of the hiatal orifice were measured, (4.33 ± 0.84 and 2.85 ± 0.85 cm, respectively). Thirteen and eight Nissen and Toupet fundoplications were performed, respectively. The intraoperative complication rate was 9.52%. Despite dysphagia, GERD-related symptoms improved significantly compared with those before surgery. The recurrence rate was 0% during the 6-mo follow-up period, and long-term follow-up disclosed a recurrence rate of 4.76% with a mean period of 16.28 mo. Eight patients developed new-onset dysphagia. The Chinese literature review identified 12 papers with 213 patients. The overall recurrence rate was 1.88%. There was no esophageal erosion and the rate of dysphagia ranged from 0% to 24%.
  
  
  CONCLUSIONS
  The use of Crurasoft® mesh for HH repair results in satisfactory symptom control with a low recurrence rate. Postoperative dysphagia continues to be an issue, and requires more research to reduce its incidence.
authors.affiliation: Wei Zhang, Cheng-Xiang Shan, Sheng Liu, Zhi-Guo Jiang, Dao-Zhen Jiang, Xiang-Min Zheng, Ming Qiu, Department of General Surgery of Changzheng Hospital affiliated to the Second Military Medical University, Shanghai 200003, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Tang
authors.forename: Cheng-Xiang
authors.initials: CX
authors.lastname: Shan
authors.forename: Sheng
authors.initials: S
authors.lastname: Liu
authors.forename: Zhi-Guo
authors.initials: ZG
authors.lastname: Jiang
authors.forename: Dao-Zhen
authors.initials: DZ
authors.lastname: Jiang
authors.forename: Xiang-Min
authors.initials: XM
authors.lastname: Zheng
authors.forename: Ming
authors.initials: M
authors.lastname: Qiu
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh; D055815:Young Adult
keywords: Anti-reflux surgery; Gastroesophageal reflux disease; Hiatal hernia; Mesh; Prosthetic
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