Abstract

Abstract Background Mesh reinforcement of the oesophageal hiatus decreases recurrence rates for giant paraoesophagal hernias. The use of permanent synthetic mesh is associated with significant risk of erosion which is not observed in absorbable biosynthetic mesh – with the trade-off long-term hernia recurrence. We aim to assess the safety and effectiveness of Phasix™ nonST mesh in the repair of giant paraoesophageal hernias. Method Patients presenting to Bankstown hospital in 2020–21 with giant paraoesophageal hernias were included. 7 × 10 cm Phasix™ nonST mesh, fashioned in a standardised configuration was inserted behind the oesophagus, secured with fibrin glue and monofilament sutures. A modified Dor technique was used. Primary endpoint was early endoscopic recurrence and secondary endpoints were length of hospital stay, morbidity, mortality and symptom recurrence. Results Thirty-two patients (mean age 68.1 years) with giant paraoesophageal hernias underwent laparoscopic Phasix™ nonST mesh repair with modified Dor fundoplication in 32 cases. Dyspnoea (63.6%), epigastric/chest pain (48.5%), and dysphagia (51.5%) were the most common symptoms. Reflux was negligible. There were 62.5% type III and 15.6% type IV hernias. Thirty-five (85%) patients had more than 50% herniation of the stomach. Median length of stay was 3 days and 97% were symptom free at 12 and 24 months. There was no major complication and no mortality. There was one endoscopic and radiological recurrence was found in one (3.1%) patient at 24 months. Conclusion Phasix™ non ST mesh reinforcement of the oesophageal hiatus with fibrin glue fixation shows promise in reducing recurrence rates for repair of giant paraoesophageal hernias.