BACKGROUND: Previous studies have shown that surgical repair of @entity357 is associated with a high recurrence rate, especially when a laparoscopic approach is used. Anatomic recurrence due to crura breakdown is a primary etiology, which has led us to employ prosthetic mesh reinforcement of large hiatal defects (> 5 cm) since 1996. We discuss the evolution of this approach and describe our current technique with limited outcomes in 52 consecutive @entity1 during a 5-year period. METHODS: There were 31 males and 21 females, with a mean age of 57 years (range, 32-77 years) with symptomatic reflux and endoscopic or radiologic evidence of a large @entity357 . Utilizing a laparoscopic approach, the contents of the sac were reduced and the crura approximated with permanent interrupted sutures and a prosthetic mesh was secured over the repair as an on-lay reinforcement buttress. A Nissen (42) or Tilley (9) fundoplication was performed in all but 1 @entity1 , and 18 @entity1 (34%) required a wedge collis gastroplasty. Fifteen @entity1 (28%) had a previous unsuccessful antireflux operation. RESULTS: There was no perioperative morbidity or mortality. Follow-up averaged 25 months (range, 7-60 months). Postoperative gastroscopy or barium swallow have been performed in 27 @entity1 to date, with 11 experiencing foregut symptoms. There has been 1 recurrence (1.9%) and no @entity2681 . CONCLUSION: Early results suggest that prosthetic mesh cruroplasty may be effective in reducing recurrence after laparoscopic repair of large @entity357 , but long-term follow-up is required in all @entity1 to determine the true incidence of anatomic recurrence and @entity2681 .

Laparoscopic mesh cruroplasty for large XXXX .

@entity357 :: ('MESH:D006551', 'Disease') :: ['paraesophageal hernia', 'paraesophageal hernias'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity2681 :: ('MESH:D014077', 'Disease') :: ['prosthetic erosion']
@entity357 :: (MESH:D006551,Disease) :: ['paraesophageal hernias']
