Carneiro, T

Gomes, A

Leão, P

Luís, D

Macedo, G

Machado, A

Oliveira, M

Pereira, P

Rolanda, C

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Repositório Comum

Prosthetic Esophageal Transmural Erosion After Mesh Hiatoplasty Pedro Leão1, Teresa Carneiro1, Mário Oliveira1, Dina Luís1, Carla Rolanda2,  Artur Machado2, Pedro Pereira2, Guilherme Macedo2, António Gomes1 1-Surgery Department; Hospital de São Marcos - Braga, Portugal 2-Gastroenterology Department; Hospital de São Marco - Braga, Portugal pedroleao@ecsaude.uminho.pt  Identification Female  68 years old,   Past medical history. Asthma  History of present illness  She was submitted to anti-reflux surgery through laparoscopic (Nissen fundoplication) for hernia of the esophageal hiatus (type I). One year after the first surgery, for received hernia of the esophageal hiatus, the patient was submitted to laparotomy with placement of politetrafluoroetileno (PTFE) prosthesis peri-esophageal and splenectomy by iatrogeny. Eight months after the last intervention , it falls back upon emergency room of São Marcos Hospital for dysphasia (for solids and liquids).   Complementary examination She accomplished high disgestive endoscopy that revealed transmural migration (Fig. 1) of the prosthesis into the distal esophagal lumen; Endoscopical extraction of the prosthesis was not possible.  Surgical treatment Surgical correction in two times:  First time with prosthesis extraction (Fig. 2a, 2b e 3) and sub-total esofagectomy with esophageal exclusion, cervical esophagostomy and jejunostomy for feeding;  Second time almost total esofagectomy with retroesternal esophagocoloplasty.  Evolution  She was discharged home 41 days after the last surgery. Having developed a mild stenosis (Fig.4) of esophagoileocolic anastomosis, endoscopic dilatations and endoluminal prosthesis became necessary (Fig. 5). Case Report The problem of esophageal mesh erosion must be approached surgically. Endoscopic removal should be attemped but may be unsuccessful if the mesh is well anchored in the esophageal wall. Although it is usually expected that extensive esophagogastric resection and reconstrution will be required.   Conclusion References Introduction Intrathoracic warp herniation from crural repair break-down is a well recognized complication of Nissen fundoplication1,2. To counter this problem, some surgeons recommend the use of mesh prosthesis to buttress the cruroplasty, both for open and laparoscopic hiatal repair2. Schols and Richards have strongly cautioned the use of mesh because of concerns of erosion and stricture3.   In the adult population, there are reports of up to 26% intrathoracic warp migration rate after laparoscopic fundoplication and up to a 41% recurrent rate after laparoscopic paraesophageal hernia repair2. There are five reports in literature of mesh erosion after hiatal repair3. 1 - Dutta S. 2007. Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery. J Pediatr Surg. Jan;42:252-256 2 - Johnson JM, Carbonell AM, Carmody BJ, Jamal MK, Maher JW, Kellum JM, DeMaria EJ. 2006. Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications: a critical analysis of the available literature. Surg Endosc. Mar;20:362-366  3 - Targarona EM, Bendahan G, Balague C, Garriga J, Trias M. 2004. Mesh in the hiatus: a controversial issue. Arch Surg. Dec;139:1286-1296. . Figure 3 Figure 5 Esophageal prothesis Figure 2b Mesh erosion Line suture of polar  gastrectomy Figure 4 Stenose of anastomosis Figure 2a Stomach Esophageal mesh erosion Figure 1 Mesh erosion Mesh prothesis 

Prosthetic Esophageal Transmural Erosion After Mesh Hiatoplasty

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Prosthetic Esophageal Transmural Erosion After Mesh Hiatoplasty

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