Mesh placement for hiatal hernia repair : Can we solve the controversy?
Balaguè Ponz, Carmen (Institut d'Investigació Biomèdica Sant Pau)
Fernández-Ananín, Sonia (Institut d'Investigació Biomèdica Sant Pau)
Sacoto, D. (Universitat Autònoma de Barcelona)
Targarona, Eduardo M. (Institut d'Investigació Biomèdica Sant Pau)

Fecha:	2021
Resumen:	Hiatal hernia is a common disorder characterized by the protrusion of abdominal structures other than esophagus in thoracic cavity. Large hiatal hernias, also called paraesophageal hernia (PEH), contain a large part of the stomach, including other organs, into the mediastinum. The Guidelines of Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommends that patients' age and comorbidities must be considered before to decide the routine elective repair of asymptomatic PEH. Nevertheless, truly asymptomatic PEH are rare and post-prandial chest fullness or shortness of breath are often the symptoms present instead of heartburn and reflux. The complete reduction of the mediastinal sac with a wide esophageal mobilization and a tension-free hiatal closure are necessary for a correct PEH repair. However, a tension-free cruroplasty is not easy, with a recurrence rate of up to 42%. The introduction of synthetic mesh (SM) reinforcement, could ameliorate the results and several studies have reported lower recurrence rates with its use. However, also severe complications have been reported and biological meshes (BMs) have been proposed as an alternative although with conflicting results regarding efficacy. On the other hand, several studies describe better clinical results on long term follow-up than expected even with a high radiological recurrence rate.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Hiatal hernia ; Biological mesh (BM) ; Nonabsorbable mesh ; Polytetrafluoroethylene (PTFE) ; Polypropylene (PP)
Publicado en:	Laparoscopic Surgery, Vol. 5 (2021) , p. A8, ISSN 2616-4221

DOI: 10.21037/ls-20-89

8 p, 226.6 KB

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