Successful endoscopic mesh removal after laparoscopic Nissen fundoplication.

A 72-year-old male was admitted because of dysphagia for solids and liquids. He had undergone a laparoscopic Nissen fundoplication due to erosive esophagitis and hiatal hernia. Three years later, due to symptomatic recurrence of the hernia, surgery with placement of a polypropylene mesh was indicated. After four years he developed epigastric pain and dysphagia for liquids. Gastroduodenoscopy showed a polypropylene mesh occluding almost all the esophageal lumen (Fig. 1). The symptoms worsened, with dysphagia for solids and liquids, with weight loss. First of all, we decided to remove the mesh endoscopically.A first attempt was done by exerting strong traction on the mesh with biopsy forceps without any result. At this point we looked for each one of the blue Prolene 3/0 (Fig. 2A) sutures and cut them with endoscopic scissors FS – 3L1 and FS – 5U 1 (Fig. 2B) (Olympus, Tokyo, Japan). The mesh was extracted successfully in two Successful endoscopic mesh removal after laparoscopic Nissen fundoplication