Prolene Suture Web-Shoelace-Like Pattern: An Alternative to Avoid the Use of Mesh in the Repair of a Large Hiatus Hernia.

INTRODUCTION: The purpose of this report is to describe a tension-free repair we have used successfully in 12 patients with large hiatal defects. It is based on the creation of a web-shoelace pattern of polypropylene (Prolene®; Ethicon, Somerville, NJ) suture of the crura that functions as a barrier, with the advantages of being stronger and more economical than a mesh without the potential complications that may follow mesh repair or suture repair of a large hiatus hernia without mesh. Despite a success rate of 85%-95% reported in large series with a mid- and long-term follow-up evaluation, significant complications have been associated with hiatus hernia repair. Some of these complications include a slipped Nissen repair with intrathoracic wrap migration and hiatal hernia recurrence, resulting from inadequate closure of the crura, fundoplication disruption, or dehiscence of the hiatoplasty.

MATERIALS AND METHODS: From June 2013 to June 2014, we have used this technique on 12 patients (6 women and 6 men). Only patients with a large hiatus hernia of >4 cm were enrolled in this study. All patients underwent laparoscopic Nissen fundoplication and hiatoplasty using our technique. They were all severely symptomatic with dysphagia, retrosternal pain, gastroesophageal reflux disease, and respiratory symptoms at night.

RESULTS: Of the 12 patients who underwent this type of repair, all of them have reported good to excellent functional and symptomatic outcomes with minimal morbidity, no deaths, and no recurrence.

CONCLUSIONS: It is our belief that when a correct repair of the hiatus is not achieved with three stitches, adding more sutures will not lead to a tension-free repair, and this hiatoplasty will have an increased risk of dehiscence. It is for this reason that we recommend using our technique instead of using simple nonabsorbable sutures or a prosthetic mesh.