We reviewed the literature to evaluate the current status of hiatal mesh repair in Western countries and introduce our procedure using ParietexTM composite mesh. Faced with large hiatal defects and a high recurrence rate, some early surgeons advocated the use of artificial material for closure of the defect. The first report of the use of a prosthetic material to reinforce crural repair was in 1960. Thereafter, some surgeons reported that mesh prosthesis-reinforced hiatus hernia repair was effective and appeared to have a low recurrence rate. Mesh hernia repair is the standard procedure to treat giant hiatal hernia in Western countries. However, this procedure is less common in Japan, and indications for mesh use have not been established. We determined the indication at our institution as follows: 1) type III hiatal hernia, 2) hiatal defect size > 5cm, and 3) weak crus that tears easily with crural repair. During the operation, we insert and use 5 trocars and return the stomach to its normal position. The hernia sac should be removed as far as possible to prevent hernia recurrence. We suture the crus and place mesh to reinforce the hiatal defect. The mesh was anchored with tacks, which allow the mesh to be easily placed. ParietexTM composite mesh, the first mesh for hiatal hernia repair introduced in Japan, is coated on 1 side with a protective collagen-based barrier to help prevent tissue attachment. The mesh is created in the shape of the hiatus to buttress the primary repair by reinforcing the approximation of the crus on either side of the esophagus. We are satisfied with this mesh because it makes hiatal repair a safe and simple procedure. In conclusion, mesh replacement in hiatal hernia repair should be promoted, and the operative indications for hiatal mesh repair should be determined in Japan.
