Mesh in the hiatus: a controversial issue.

Objective: To analyze the experience acquired to date on the use of prosthetic mesh to prevent recurrence after laparoscopic repair of paraesophageal hernia.

Data Sources: Current English-language literature review.

Study Selection: Case reports, series, and opinion articles on the use of mesh for paraesophageal hernia repair.

Data Extraction And Synthesis: Study type and results were analyzed. Most articles were short case series. Few comparative or randomized trials assessing the procedure have been published to date. The information available showed that the use of a mesh for hiatal repair was safe and prevented recurrence. However, data on the long-term results were lacking, and infrequent but severe complications may arise.

Conclusions: The mesh should be used selectively, and the decision to proceed should be based on clinical experience. In light of the evidence available, however, it appears to be safe, and the fears expressed in the past have not been confirmed.