Laparoscopic repair of gastroesophageal reflux disease (GERD) and paraesophageal hernias (PEH) has become the treatment of choice [
1]. Although there is an increasing experience with laparoscopic paraesophageal hernia (LPEH) repair, studies observed recurrence rates of up to 43% with simple, primary suture of the hiatus [
2]. Furthermore, Granderath et al. noticed a high rate of intrathoracic wrap migration of 26% in patients undergoing laparoscopic fundoplication (LF) with primary sutured hiatal repair [
3]. Kamolz et al. observed that mesh-reinforcement of the hiatal crura reduced the risk of recurrent hiatal hernia and led to an improved quality of life compaired to patients without mesh prothesis [
4]. It seems as if use of prosthetic inforcement of the hiatus becomes routine in clinical practice [
5‐
7]. However, authors continue reporting of stricture, dysphagia, ulceration, perforation or even mesh migration into the oesophagus caused by use of alloplastic mesh material for hiatoplasty [
7‐
9]. Moreover, there are still controversies about the technique of mesh placement, shape, structure and material [
7,
10,
11]. Various materials have been investigated (polypropylene mesh, polytetrafluoroethylene mesh, acellular dermal allograft). The results of these studies base on clinical outcomes in most cases [
1,
5,
12‐
14]. Desai et al. presented a canine model and reported on histological results one year after bioprosthetic repair of paraoesophageal hernia with a new small-intestinal submucosa mesh (SIS). They found no evidence of erosion of SIS mesh into the eosophagus [
15]. Following this canine model, we performed an animal study to examine functional and histological changes in the distal eosophagus after implantation of two different mesh material [polypropylene (PP), Prolene
®; polypropylene-polyglecaprone 25 composite (PP-PG), Ultrapro
®]. Data of the clinical outcome of this study were already published by our group [
16]. We observed distinctive mesh shrinkage after three months in all animals. Some meshes had lost up to 50% of their original size. We found a delayed passage of fluid into the stomach of all operated animals. Furthermore we found a mesh migration into the esophageal wall in six out of seven animals (PP) and five out of nine animals (PP-PG), respectively [
16].
In the present study we assessed the histologic characteristics, tissue integration and scar formation after prosthetic enforcement (PP and PP-PG) of the hiatus in a rabbit model.