Pre-Existing Mesh at the Hiatus in Revisional Surgery Does Not Result in Increased Morbidity: A Case-Control Evaluation.

BACKGROUND: Mesh is sometimes used to reinforce the hiatus during primary and reoperative fundoplication. This is a controversial practice as it is not clear that this leads to a decreased rate of failure of the hiatal closure, and concerns about morbidity related to the presence of mesh in this location exist. One of these concerns is that if reoperation is ever required (fundoplication herniates through the hiatus, for example), revisional surgery would be significantly more difficult and associated with a higher rate of morbidity than if mesh had not been placed at the hiatus in a previous procedure.

METHODS: A retrospective review was conducted of prospectively collected data on 104 patients to undergo surgery for a failed fundoplication between 2011 and 2015. Fourteen patients (13.5%) had previous operations where mesh had been placed at the hiatus and underwent a subsequent revisional procedure. Procedures performed were reoperative fundoplication and Roux-en-Y gastric bypass as a salvage procedure for a failed fundoplication, especially in the setting of obesity. These 14 cases were matched 1:2 with randomly selected control patients from the database who underwent revisional surgery in whom mesh had not been placed at the original operation. Cases and controls were paired based on the number of previous revision attempts and operation type. Perioperative outcomes were compared.

RESULTS: There was no statistically significant difference in 30-day morbidity, readmission, operative time, or length of hospital stay.

CONCLUSIONS: In this retrospective case-control evaluation, mesh at the hiatus did have an impact on morbidity or operative time.