Biologic Keyhole Mesh in Hiatal Hernia Repair

Area of Science:

• Gastroenterology
• Surgical Innovation
• Hernia Repair

Background:

• Laparoscopic paraesophageal hernia repair (LPEHR) is standard, but mesh use remains debated.
• Biologic mesh shows promise, yet only U-shaped onlay is well-studied.
• Keyhole mesh adoption was slowed by dysphagia concerns.

Purpose of the Study:

• To determine the incidence of postoperative dysphagia after LPEHR with keyhole biologic mesh.
• To evaluate the safety and efficacy of novel keyhole biologic mesh placement.

Main Methods:

• Retrospective review of 30 consecutive patients undergoing LPEHR.
• Primary suture cruroplasty with human acellular dermal matrix keyhole mesh reinforcement.
• Postoperative symptoms and radiographic recurrence were assessed.

Main Results:

• No increase in postoperative dysphagia observed (3/30 had preoperative dysphagia).
• Mild reflux symptoms occurred in 20% of patients.
• Two slight recurrences (18%) noted in large hiatal hernias; no complications.

Conclusions:

• LPEHR with keyhole biologic mesh has low recurrence and no increased dysphagia.
• The study did not support traditional beliefs linking keyhole mesh to higher dysphagia rates.