AQUEDADAPRESSAOPORTAL APOSDESVASCULARIZACAO LAPAROSCOPIC ANTIREFLUX SURGERY: ARE OLD QUESTIONS ESOFAGOGASTRICAE ESPLENECTOMIA INFLUENCIA A VARIA ANSWERED? MESH HERNIOPLASTY

Walter de Biase SILVA-NETO1, Claudemiro QUIRESE1, Eduardo Guimaraes Horneaux de MOURA2, ABSTRACT: Hiatal hernias are at high risk of recurrence. Mesh reinforcement after primary approximation of the hiatal crura has been advocated to reduce this risk of recurrence, analogous to mesh repair of abdominal wall hernias. However, the results of such repairs have been mixed, at best. In addition, repairs Fabricio FerreiraCOELHO3, PauloHERMAN3 using some type of mesh have led to significant complications, such as erosion and esophageal stricture. At present, there is no consensus as to (1) whether mesh should be used, (2) indications for use, (3) the type of mesh, and (4) in what configuration. This lack of consensus is likely secondary to the notion that recurrence occurs at the site of crural approximation. We have explored the theory that many, if not most, "recurrences" occur in the anterior and left lateral aspects of the hiatus, normally where the mesh is not placed. We theorized that "recurrence" actually represents progression of the hernia, rather than a true RESUMO -Racional: O tratamento de escolha para pacientes com hipertensao portal recurrence. This has led to our development of a new mesh configuration to enhance the tensile strength of the hiatus and counteract continued stresses from esquistossomotica com sangramento de varizes e a desconexao azigo-portal mais intra-abdominal pressure.