Prosthetic bioabsorbable mesh for hiatal hernia repair during sleeve gastrectomy

Abstract

Background and Objectives: Laparoscopic sleeve gastrectomy has become a valuable primary bariatric operation. It has an acceptable complication profile and amount of weight loss. However, one of the most distressing complications to the patient is reflux postoperatively. There is thought to be a relationship between a hiatal hernia and postoperative reflux. There is disagreement on how to address a hiatal hernia intraoperatively, and the use of mesh is controversial. Our objectives were to examine the use of a prosthetic bioabsorbable mesh for repair of a large hiatal hernia during a sleeve gastrectomy and to examine the incidence of reflux and mesh-related complications in the near term. Methods: This is a case series of patients with hiatal hernia undergoing a primary sleeve gastrectomy. None of the patients had a previous hiatal hernia repair. Three patients with large hiatal hernias diagnosed preoperatively or intraoperatively were included. The hiatus of the diaphragm was repaired with a posterior crural closure, and a piece of prosthetic bioabsorbable mesh was placed posteriorly to reinforce the repair. Results: There were 3 patients. The mean follow-up period was 12 months. There were no mesh-related complications. One of the patients needed to resume proton pump inhibitors to control reflux. Conclusion: The use of a prosthetic bioabsorbable mesh to repair a hiatal hernia simultaneously with a sleeve gastrectomy is safe. There were no mesh-related complications at 1 year. © 2013 by JSLS, Journal of the Society of Laparoendoscopic Surgeons.