Antireflux Surgery with Routine Mesh Hiatoplasty

Excerpt

We read with much interest the study of Kepenekci, “Laparoscopıc Fundoplicatıon with Prosthetic Hiatal Closure” [1]. It helps to dispel the fear of prostheses, showing that they are safe and important to use. However, we have a few concerns about the article. Failure of hiatal hernia surgery and the recurrence of hiatal hernia are due to excessive stress on the hiatoplasty suture and the hiatal diameter. Therefore, we could not agree more with the author that if hiatoplasty depends solely on the suture it is ineffectual and leads to disruption and thus high rates of recurrence [1, 2]. This is not seen in the corrections using mesh [3, 4, 5]. As in Kepenekci’s conclusion, we also advocate the routine use of mesh in hiatoplasty. However, one of our concerns is that there is no uniform protocol or standardized procedure for mesh fixation and size. …