Prevention of cardiac injuries during hiatal hernia repair with mesh

Objective: To evaluate effectiveness of our designed method of cardiac injury prevention during hiatal hernia mesh repair. Methods: We performed hiatal hernia repair in 317 patients and hiatal hernia mesh repair in 41 patients with large hernia size and weak of hiatal tissues. We used sutures in 15 patients, straight tackers in 2 patients, flexible tackers with absorbable tacks in 14 patients and combination of straight tackers and sutures in 9 patients. Results: Several techniques were developed to prevent cardiac injury. Reccurence of hiatal hernia was detected in 3 patients with large paraesophageal her- nia and in 5 patients with mixed type hernia after mesh-free hiatoplasty. No recurrence after mesh hiatoplasty was detected. Conclusions: The optimal is using flexible tackers and absorbable tacks. Mesh should be fixed except left upper part of hiatus (from 12:00 to 16:00). Tacks should be inserted near the edge of mesh aperture from pericardium to esophagus perpendicular to crura. Cruroraphia is advisable when possible. Further studies needed to evaluate the outcome-related significance of this techniques.