Transmural gastric mesh migration after hiatal hernia repair: Case report and literature review

Abstract

Introduction

Mesh reinforcement of the hiatus has been shown to reduce the hernia recurrence rate. But serious related complications have been reported including bleeding, erosion or migration, infection, stricture, and adhesions. Complete transmural gastric migrations of the mesh have been rarely cited in the literature.

Case

We herein report a case of a 62-year-old woman who presented for dysphagia and weight loss, 2 years after hiatal hernia repair with mesh cruroplasty. On endoscopy, complete transmural mesh migration into the stomach was identified, but it was difficult to remove. The mesh was then removed surgically.

Discussion

The possible mechanism of mesh erosion can be related to the anatomy of the distal esophagus, fixation, position, and distance of the mesh to the esophagus when placed at surgery. Endoscopic mesh retrieval is the first line of treatment when safe and feasible. Other surgical treatments in case of failure of endoscopic removal are case by case depending on the position of the mesh and the extent of organ injury. Surgery can be done laparoscopically or via laparotomy.

Conclusion

In conclusion, dysphagia may manifest during the early postoperative period after mesh repair antireflux surgery, but such dysphagia usually resolves; if it doesn’t or if it worsens, mesh migration must be excluded