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Surgical Endoscopy
Published in: Surgical Endoscopy 2/2015

01-02-2015

Long-term outcomes of radiologic recurrence after paraesophageal hernia repair with mesh

Authors: Rachel Jones, Anton Simorov, Daniel Lomelin, Carl Tadaki, Dmitry Oleynikov

Published in: Surgical Endoscopy | Issue 2/2015

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Abstract

Introduction

Paraesophageal hernia (PEH) repair has a high radiologic recurrence rate, even with the use of biologic mesh as a prosthetic buttress to reinforce the primary crural repair. This review was done to evaluate outcomes after PEH repair with mesh.

Methods

A retrospective analysis was done of all patients who underwent PEH repair with mesh at our institution between December 2004 and March 2013. Patients were reviewed for evidence of recurrence on upper gastrointestinal studies (UGI). Time-specific, mesh-specific, and size-specific recurrence was analyzed as well as pre- and postoperative symptom scores.

Results

A total of 209 patients underwent PEH repair with mesh. Mean follow-up was 25 months (range 0–101). In all cases, an absorbable mesh was used (159 Alloderm, 35 BioA, 15 Strattice). One hundred and fifty-six (75 %) were 5 cm or larger. Of the patients, 166 (79 %) had UGIs available to review for radiologic recurrence. Total recurrence was 21 % (n = 35). No mesh erosions were seen. Recurrence rates increased over time from 16 % (n = 23) at 1 year up to 39 % after 5-year follow-up (n = 11). Recurrence rates were higher for large hernias (23 vs. 16 %). The median size of the recurrence was 4 cm (range 2–7 cm). Overall, patients showed significant improvement in their symptom scores. At long-term follow-up, heartburn had 70.6 % reduction (p < 0.05) and regurgitation had 76.5 % reduction (p < 0.05). There was no significant difference in postoperative symptom scores between patients with or without radiologic recurrence.

Conclusions

In this study, PEH repair with mesh was safe and effective at controlling symptoms over the long term. Radiologic recurrence rate increased over time and was highest in patients with hernias >5 cm. Therefore, in our experience, PEH repair with mesh is a safe therapy and though radiologic recurrence does increase with time, symptom resolution is maintained.
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Metadata
Title
Long-term outcomes of radiologic recurrence after paraesophageal hernia repair with mesh
Authors
Rachel Jones
Anton Simorov
Daniel Lomelin
Carl Tadaki
Dmitry Oleynikov
Publication date
01-02-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3690-8

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