Use of mesh for hiatal hernia repair: a survey of SAGES members

Background Mesh use during hiatal hernia repair (HHR) has been suggested to be safe and effective. Concern has been raised about the risk of mesh-related complications, and the higher risk of complications if revisional hiatal surgery is undertaken after mesh has been used. Available data have not established a clear role for mesh in HHR. To assess surgeons' adoption of the use of mesh for HHR, SAGES members were surveyed regarding their practice related to mesh use for HHR. Methods Between April and September 2010, an internet-based survey tool was used to survey SAGES members. Potential participants were contacted via e-mail and invited to complete the survey. Of the 5,323 attempted contacts, 5,024 reached active e-mail accounts. From these, 2,518 members responded (50% response rate). Results The majority of respondents currently perform HHR (69%), but only 18% perform more than 20 per year. Of those who perform HHR, 94% use a laparoscopic approach for the majority of repairs. Whereas 25% of surgeons use mesh for the majority of repairs, 23% of surgeons never use mesh. When mesh is used, an absorbable mesh is most commonly used (67%). An onlay technique is used by 93% of respondents. Only 7% of surgeons who have been in practice more than 20 years use mesh compared with 59% of surgeons in practice less than 10 years. Fifty-seven percent of surgeons have never performed revisional foregut surgery on a patient with prior mesh. Conclusions Although the majority of surgeons have used mesh for HHR, it is the minority who use it routinely, with younger surgeons more likely to use mesh than older surgeons. Absorbable mesh is most commonly used. When mesh is used, an onlay technique is most commonly used. There is no clear accepted use of mesh in hiatal hernia repair.