When helpful becomes harmful: a case-based narrative review of esophageal mesh migration after hiatal hernia repair

Hiatal hernia (HH) repair with mesh reinforcement is a commonly performed procedure to reduce the recurrence of HH. Mesh migration (MM) remains a rare but serious complication.

The aim of this study was to analyze the existing literature on MM after HH repair in the context of a clinical case discussion.

This study is a nonsystematic narrative review supplemented by a case report.

A 70-year-old woman who underwent HHR with partially absorbable Seramesh PA DRUM mesh was diagnosed with MM into the esophagus 9 months postoperatively. The esophageal fistula was treated successfully with endoscopic vacuum therapy. Three-month follow-up showed stable oral intake without symptoms. MM is influenced by mesh material, fixation technique, and esophageal dynamics. Clinical presentation often includes dysphagia, pain, and weight loss, while diagnosis relies on endoscopy imaging. Management strategies vary from observation to endoscopic or surgical removal, with minimally-invasive approaches preferred when feasible. This case is the first reported instance involving the Seramesh PA DRUM mesh, and highlights the potential role of immune dysregulation and hypersensitivity in MM.

Early recognition, individualized management, and the use of minimally-invasive techniques may improve outcomes. Continued research and long-term follow-up are essential to better understand risk factors and establish optimal treatment strategies.