To analyze the factors of clinical application of mesh in the treatment of postoperative recurrence of esophageal hiatal hernia.

A retrospective analysis was performed of 15 patients who used mesh-reinforced esophageal hiatus hernia (HH) repairs and had recurrence of HH after surgery from November 2010 to May 2021 in the Department of Thyroid Breast Hernia of Shanghai Changzheng Hospital. The subjective indicators are mainly based on the modified Visick scoring system. The objective indicators include gastroscopy, upper gastrointestinal barium meal, upper abdominal CT and high-resolution esophageal pressure measurement and 24-hour pH monitoring during the six months postoperative follow-up. Patients with symptomatic recurrence should first be assessed by imaging examinations for objective evidence. For those with recurrent symptoms but no clear evidence of anatomical recurrence, esophageal pressure measurement and 24-hour pH monitoring for impairment of the anti-reflux barrier function and pathological reflux are required. Impedance examination was required to evaluate the correlation between reflux and symptoms if necessary.

The recurrence time of 15 patients was 6-121 months after the initial operation, with a median time of 28 months. Among them, 4 cases were small HH (type Ⅰ-Ⅱ) and 11 cases were huge HH (type Ⅲ-Ⅳ). The number of 3 types of meshes used was 5 cases of 4-layer SIS, 8 cases of 6-layer SIS, and 2 cases of composite mesh. There were 10 cases of recurrent fever and gastric reflux, all of which used biological mesh; 3 cases had dysphagia as the main manifestation (2 cases of them used composite mesh). 4 cases had symptoms that did not correspond to the examination results, accounting for 26.66%. Two patients' postoperative upper abdominal CT showed HH recurrence, but with no obvious recurrence of GERD symptoms; 2 patients reported recurrence of GERD symptoms, but with no clear evidence of HH recurrence on imaging, and with no pathological reflux in esophageal pressure measurement and pH-impedance monitoring. Psychological evaluation of these 2 patients suggests mild anxiety. 4 cases underwent re-operation exploration, including 1 case with synthetic mesh and 3 cases with biological mesh. The preoperative evaluation showed different degrees of HH recurrence. A biopsy was taken from the site where the mesh (synthetic mesh) was located. Synthetic fibrous tissue with significant collagen deposition and encapsulation was seen.

In terms of the application of mesh in the treatment of postoperative recurrence of esophageal hiatal hernia, the analysis of its correlation with changes in anatomical structure is the key to deciding whether to have reoperation or not.