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Correspondence and Brief Communications
November 1, 2007

Prosthetic Hiatal Closure During Laparoscopic Nissen Fundoplication—Reply

Arch Surg. 2007;142(11):1111. doi:10.1001/archsurg.142.11.1111-a

In reply

We appreciate the interest of Dr Csendes in our article and thank him for his comments. As well as in previous studies, the key aspect of this article was to focus on the effect of the use of a prosthetic mesh for hiatal closure during laparoscopic antireflux surgery (LARS). Recent publications could prove the beneficial effect of a hiatal mesh application regarding the postoperative hiatal hernia recurrence with or without intrathoracic migration of the fundic wrap.1,2 However, there is still discussion about the size or shape of these meshes. In our mind, the reason for using a small mesh is to ensure a sufficient closure of the hiatal crura on the one hand and minimize the risk for esophageal erosion or mesh migration on the other hand. In our own experience with a prospective randomized trial comparing patients who underwent LARS with and without hiatal mesh prosthesis, we found out that even the application of a small 1 × 3-cm polypropylene mesh for posterior mesh cruroplasty results in a significantly lower rate of postoperative intrathoracic wrap migration. In spite of these results, we found a significantly higher rate of short-term dysphagia in the patients who underwent prosthetic hiatal closure.3 As a result, the main purpose of this current study was to clarify the morphological cause of this higher dysphagia rate and particularly answer the question whether there is a correlation between mesh-related dysphagia and esophageal body motility and/or lower esophageal sphincter (LES) characteristics.

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