Complete transmural gastric migration of PTFE mesh after surgery for a recurrent hiatal hernia

V. Porziella, A. Cesario, F. Lococo, S. Margaritora, G. Leuzzi, M. Marchese, L. Petruzziello, G. Costamagna, P. Granone

Department of Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy. vporziella@rm.unicatt.it
Department of Thoracic Surgery, Centro Oncologico Fiorentino, Florence, Italy
Digestive Endoscopy Unit, Catholic University of the Sacred Heart, Rome, Italy
Deputy Scientific Director, IRCCS San Raffaele Pisana, Rome, Italy

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• Gastroenterology

Complications directly associated with the use of prosthetic materials in large hiatal hernia repair are rarely cited events in the literature. We herein report a case of a 47 year-old woman who came to our attention for a subacute onset of severe dysphagia and weight loss. She previously underwent  laparotomic Nissen fundoplication with PTFE dual-mesh cruroplasty for a large recurrent hiatal hernia. With the clinical suspicious of “Tight Nissen”, an endoscopy was performed and revealed a circular stenosis in the lower esophagus, a rotation of the stomach and, surprisingly, the presence of PTFE mesh free-moving in the gastric lumen With the use of rattooth forceps, the foreign body was removed and, after few days, the patient underwent a surgical debridement of hiatal scar tissue and a gastropexy procedure.

In conclusion, dysphagia may manifest during the early postoperative period after mesh repair antireflux surgery, but such dysphagia usually resolves; if it doesn’t or if it worsens, mesh migration must be excluded.

Published on: 2012/10/17

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