Migrasyon Olan Nissen Fundoplikasyon Meshinin Endoskopik Çıkarılması

Abstract

Laparoskopik Nissen fundoplikasyonunun hiatal hernilerin tedavisi için güvenli ve uygulanabilir bir yöntem olduğu bilinmektedir. Bununla birlikte, %42 gibi bir nüks oranı da bildirilmiştir. Nissen fundoplikasyonu yapılan hastalarda meş onarımının kullanılması, bildirilen birkaç komplikasyon olmuş olsa bile, primer sütüre göre daha az nüks göstermiştir. Meş konulmasıyla oluşabilecek bazı komplikasyonlar şunlardır; şiddetli fibrozis, özofagus darlıkları, özofagus perforasyonları, barsak duvarında meş erozyonu ve üst gastrointestinal sisteme meş migrasyonu, vb. Bu raporda, yaklaşık 11 yıl sonra gelişen meşin özofagusa migrasyonu sunulmuştur. Bu gibi durumlarda, hastalarda birkaç cerrahi seçenek bulunabilir. Bu seçeneklerin arasından, endoskopik olarak meş tamamen yerinden çıkarıldı. İleri cerrahiye ihtiyaç duyulmadı. Sonuç olarak, hiatal hernilerin laparoskopik onarımı için cerrahın deneyimi, hiatus anatomisi ve hastanın semptomları da dikkate alınarak çok seçici bir meş kullanılması önerilir.

Keywords

• Nissen Fundoplikasyonu
• Mesh Migrasyonu
• Endoskopik Çıkarma

Endoscopic Removal of Migrated Nissen Fundoplication Mesh

Abstract

Laparoscopic Nissen fundoplication is known to be a safe and feasible method in the treatment of hiatal hernias. However, a recurrence rate of 42% has been reported. Using mesh repair in patients undergoing Nissen fundoplication has shown fewer recurrence rates than the primary suture, even though there have been few complications reported. Some complications that may occur with mesh placement are; severe fibrosis, esophageal strictures, esophageal perforations, mesh migration to the upper gastrointestinal tract, and mesh erosion in the intestinal wall, etc. In this report, the migration of the leathery esophagus developed after about 11 years was presented. In such cases, patients may have several surgical options. Among these options, the mesh was completely removed endoscopically. No further surgery was required. In conclusion, it is recommended to use a very selective mesh in the laparoscopic repair of the hiatal hernias, considering the surgeon's experience, hiatus anatomy, and patient's symptoms.

Keywords

• Nissen Fundoplication
• Mesh Migration
• Endoscopic Removal

References

1. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, et al. Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg. 2000;190(5):553-60; discussion 560-1.
2. Carpelan-Holmström M, Kruuna O, Salo J, Kylänpää L, Scheinin T. Late mesh migration through the stomach wall after laparoscopic refundoplication using a dual-sided PTFE/ePTFE mesh. Hernia. 2011;15(2):217-20.
3. Hergueta-Delgado P, Marin-Moreno M, Morales-Conde S, Reina-Serrano S, Jurado-Castillo C, Pellicer-Bautista F, et al. Transmural migration of a prosthetic mesh after surgery of a paraesophageal hiatal hernia. Gastrointest Endosc. 2006;64(1):120; discussion 121.
4. Leitão C, Ribeiro H, Caldeira A, Sousa R, Banhudo A. Late transmural mesh migration into the esophagus after Nissen fundoplication. Endoscopy. 2016;48(Suppl 1 UCTN):E166-7.
5. Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael Brunt L, Hunter JG, et al. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009;23(6):1219-26.
6. Rodrigues-Pinto E, Morais R, Macedo G, Khashab MA. Choosing the appropriate endoscopic armamentarium for treatment of anastomotic leaks. Am J Gastroenterol. 2019;114(3):367-71.
7. de Moura DTH, de Moura BFBH, Manfredi MA, Hathorn KE, Bazarbashi AN, Ribeiro IB, et al. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc. 2019;11(5):329-44.
8. Goldschmiedt M, Haber G, Kandel G, Kortan P, Marcon N. A safety maneuver for placing overtubes during endoscopic variceal ligation. Gastrointest Endosc. 1992;38(3):399-400.

9. Rodrigues-Pinto E, Costa-Moreira P, Santos AL, Dias E, Macedo G. Endoscopic removal of migrated Nissen fundoplication mesh. VideoGIE. 2020;5(6):238-40.
10. Dugan J, Bajwa K, Singhal S. Endoscopic removal of gastric band by use of a stent-induced erosion technique. Gastrointest Endosc. 2016;83(3):654-5.