Gastric mesh erosion after hiatoplasty for recurrent paraesophageal hernia.

rent paraesophageal hernia by means of laparoscopic hiatal reinforcement using a 12 ” 10−cm titanium−covered polypropy− lene mesh. He began to experience non− specific epigastric abdominal discomfort 10 months later. An upper endoscopy re− vealed the presence of mesh at the gas− troesophageal junction (l" Fig. 1), which was then removed endoscopically, using grasping forceps (l" Fig. 2). Since the pro− cedure, the patient has been free of symp− toms, with no signs of reflux disease for 12 months at the time of writing. According to the rationale of tension−free meshed hernia repair, the use of prosthe− tic materials for repair of the hiatus in large paraesophageal hernias is increas− ingly common. Prospective randomized trials have shown that the use of prosthe− tic materials for hiatal reinforcement re− sults in a significantly lower rate of hernia recurrence [1]. It is known from the complications of in− guinal and ventral hernia surgery [2] that the main argument against mesh place− ment at the hiatus is the risk of visceral erosion. Statistically, the risk of mesh ero− sion after prosthetic hiatal reinforcement is reported to be up to 2.3 % [3]. It is post− ulated that mesh migration is prevented when the mesh placement is protected by the fundic wrap and is not in contact with the esophageal wall [4]. Endoscopic treatment is an effective as well as safe method for removal of an eroding mesh. The use of an open surgical method is not necessary as long as the eroded organ wall is still intact without evidence of any leak. In order to ensure tension−free repairs of large hiatal her− nias, the use of prosthetic materials is necessary; however, in our opinion, hiatal repair using mesh should only be carried out where appropriate, because of the risk of erosion