Surgical approach to intragastric migrated hiatal mesh
Epublication WebSurg.com, Oct 2017;17(10). URL: http://websurg.com/doi/vd01en5062
Mesh use in the laparoscopic repair of hiatal hernia is associated with fewer recurrences. However, it may cause some complications such as dysphagia, stenosis or even erosion with esophageal or gastric migration. A 61-year-old woman with a large type III hiatal hernia underwent a laparoscopic Toupet fundoplication with closure of the hiatal crura with a dual U-shaped mesh. She was symptom-free for 1 year, subsequently developing dysphagia and weight loss. An esophagogastric barium test revealed minimal contrast passage and endoscopy showed partial intragastric mesh migration. The patient was submitted to a laparoscopic removal of migrated mesh with a transgastric approach. Hiatus inspection demonstrated significant fibrosis, with plication integrity and no evidence of recurrent hernia. A gastrotomy was performed allowing to identify and remove a migrated intra-gastric mesh. Careful evaluation did not show any gastric fistula and pressure test with methylene blue showed no evidence of leak. This unusual approach avoided hiatus dissection, decreasing the risks of local complications such as perforation and bleeding. The patient had no postoperative complications, recovered well, and remained asymptomatic.