Dual-sided composite mesh repair of hiatal hernia: Our experience and a review of the Chinese literature

AIM:To summarize our experience in the application of Crurasoft ® for antireflux surgery and hiatal hernia (HH) repair and to introduce the work of Chinese doctors on this topic. METHODS:Twenty-one patients underwent HH repair with Crurasoft ® reinforcement.Gastroesophageal reflux disease (GERD) and HH-related symptoms including heartburn, regurgitation, chest pain, dysphagia, and abdominal pain were evaluated preoperatively and 6 mo postoperatively.A patient survey was conducted by phone by one of the authors.Patients were asked about "recurrent reflux or heartburn" and "dysphagia".An internet-based Chinese literature search in this field was also performed.Data extracted from each study included: number of patients treated, hernia size, hiatorrhaphy, antireflux surgery, follow-up period, recurrence rate, and complications (especially dysphagia).RESULTS: There were 8 type Ⅰ, 10 type Ⅱ and 3 type Ⅲ HHs in this group.Mean operative time was 119.29 min (range 80-175 min).Intraoperatively, length and width of the hiatal orifice were measured, (4.33 ± 0.84 and 2.85 ± 0.85 cm, respectively).Thirteen and eight Nissen and Toupet fundoplications were performed, respectively.The intraoperative complication rate was 9.52%.Despite dysphagia, GERD-related symptoms improved significantly compared with those before surgery.The recurrence rate was 0% during the 6-mo follow-up period, and long-term follow-up disclosed a recurrence rate of 4.76% with a mean period of 16.28 mo.Eight patients developed new-onset dysphagia.The Chinese literature review identified 12 papers with 213 patients.The overall recurrence rate was 1.88%.There was no esophageal erosion and the rate of dysphagia ranged from 0% to 24%. CONCLUSION:The use of Crurasoft ® mesh for HH repair results in satisfactory symptom control with a low recurrence rate.Postoperative dysphagia continues to be an issue, and requires more research to reduce its incidence.