Our Summary

The use of mesh augmentation in the surgical treatment of hiatus hernias (a condition where part of the stomach pushes up into the chest) is a subject of debate, despite its numerous advantages. The aim of such surgeries is to correct the misplaced stomach and other organs and reduce the need for risky follow-up surgeries.

The researchers reviewed the current evidence on mesh augmentation and found that it should be routinely used for large hernias (greater than 5 cm), with or without involvement of the esophagus, as it lowers the risk of hernia recurrence and the need for complex surgeries. The complications associated with the mesh are rare and can be largely avoided by using the correct implantation technique and proper materials for the mesh.

The authors suggest that the quality of evidence could be improved with more validated registry and randomized controlled studies. In other words, it’s a good technique, but more research is needed to be sure.

FAQs

  1. What is the purpose of using mesh augmentation in hiatal hernia repair?
  2. Under what circumstances is mesh augmentation recommended for hiatal hernia repair?
  3. What are the potential complications associated with the use of mesh in hiatal hernia repair and how can they be avoided?

Doctor’s Tip

Overall, the use of mesh augmentation in hiatal hernia repair can be beneficial for reducing the risk of recurrence and the need for additional surgeries. It is important to discuss this option with your surgeon and weigh the potential benefits and risks based on your individual situation. Additionally, following post-operative care instructions and making necessary lifestyle changes, such as maintaining a healthy weight and avoiding trigger foods, can help promote successful healing and prevent complications.

Suitable For

Patients who are typically recommended for hiatal hernia repair include those with large hernias (greater than 5 cm), hernias with involvement of the esophagus, and those at risk for hernia recurrence. Mesh augmentation is especially beneficial for these patients as it can reduce the need for complex surgeries and lower the risk of recurrence. However, more research is needed to further validate the use of mesh augmentation in hiatal hernia repair.

Timeline

Before hiatal hernia repair:

  1. Patient experiences symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation of food.
  2. Patient undergoes diagnostic tests such as endoscopy, barium swallow, and pH monitoring to confirm the presence of a hiatal hernia.
  3. Patient may be prescribed medications to manage symptoms and lifestyle changes to reduce acid reflux.

After hiatal hernia repair:

  1. Patient undergoes surgery to repair the hiatal hernia, which involves repositioning the stomach and repairing the opening in the diaphragm.
  2. Mesh augmentation may be used during the surgery to reduce the risk of hernia recurrence.
  3. Patient may experience some discomfort and require pain medication post-surgery.
  4. Patient is advised to follow a special diet and avoid heavy lifting and strenuous activities for a few weeks after surgery.
  5. Patient may gradually resume normal activities and experience relief from symptoms such as heartburn and difficulty swallowing.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hiatal hernia repair using mesh augmentation include:

  1. What are the benefits of using mesh augmentation in my specific case?
  2. What are the risks and potential complications associated with mesh augmentation?
  3. How experienced are you in performing hiatal hernia repairs with mesh augmentation?
  4. What is the success rate of hiatal hernia repair with mesh augmentation compared to traditional techniques?
  5. What is the recovery process like after surgery with mesh augmentation?
  6. Are there any long-term effects or considerations to be aware of with mesh augmentation?
  7. Are there any alternative treatment options to consider?
  8. How will I be monitored for potential complications post-surgery?
  9. Are there any lifestyle changes or precautions I should take after surgery with mesh augmentation?
  10. Can you provide me with more information or resources to learn about hiatal hernia repair with mesh augmentation?

Reference

Authors: Nickel F, Cizmic A, Müller-Stich BP. Journal: Zentralbl Chir. 2021 Apr;146(2):194-199. doi: 10.1055/a-1345-9841. Epub 2021 Feb 8. PMID: 33556982