Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery

Although there is evidence in the adult surgical literature to suggests that the use of mesh prosthesis during laparoscopic hiatal hernia repair results in much reduced recurrence rates, there remains a real potential for esophageal and gastric mesh erosion. A 12-year-old boy presented with esophageal obstruction from an eroded polytetrafluoroethylene prosthesis used to buttress a hiatal hernia repair 9 years earlier. A laparoscopic endogastric approach was used to remove the mesh. Great caution must be exercised in the decision to use mesh for hiatal hernia repair in children who must live with such a prosthesis for a lifetime and risk erosion. Mesh should be reserved only for those children who have extremely large defects with no chance of primary closure and for those with recurrent hernias and friable crural tissue. In all cases, the family must be informed of the potential for eventual erosion. Removal of eroded mesh using minimal access techniques can be simple and effective.