Phasix™ Non-St Mesh for Giant Paraoesophageal Hernias – The Way of the Future?

Aim Mesh reinforcement of the oesophageal hiatus decreases recurrence rates for large paraoesophagal hernias. The use of permanent synthetic mesh is associated with significant risk of erosion which is not observed with absorbable biosynthetic mesh, at the hypothetical cost of long-term hernia recurrence. We aim to assess the safety and effectiveness of Phasix™ non-ST mesh in the repair of giant paraoesophageal hernias. Material and Methods Patients presenting for elective laparoscopic mesh repair of giant paraoesophageal hernias with modified Dor fundoplication, between 2019–2021, were included in this cohort study. Phasix™ non-ST mesh was used in all patients and fixed with fibrin glue. Clinical follow-up included yearly non-contrast chest-CT and gastroscopy. Primary endpoint was early endoscopic and/or CT-scan recurrence, secondary endpoints were length-of-hospital stay (LoS), morbidity, mortality and symptom recurrence. Results Thirty two patients (mean age 68.1 years) with giant paraoesophageal hernias underwent laparoscopic Phasix™ non-ST mesh repair with modified Dor fundoplication. Dyspnoea (63.6%), dysphagia (51.5%), and epigastric/chest pain (48.5%) were the most common symptoms. Reflux was negligible. There were 62.5% type III and 15.6%% type IV hernias. Thirty five (85%) patients had more than 50% herniation of the stomach. Median LoS was 3 days and 97% were symptom free at mean 24-month follow-up. There was no major complication and no mortality. There was one endoscopic and radiological recurrence found in one patient (3.1%) at 24 months. Conclusions Phasix™ non-ST mesh reinforcement of the oesophageal hiatus with fibrin glue fixation shows promise in reducing recurrence rates for repair of giant paraoesophageal hernias.