{'fraction_non_alphanumeric': 0.022598870056497175, 'fraction_numerical': 0.012711864406779662, 'mean_word_length': 5.268436578171092, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Partial transmural gastroesophageal migration of polypropylene mesh after surgery for a recurrent hiatal hernia.

We commend Porziella et al1 on their report surrounding transmural gastric migration of PTFE mesh after prosthetic antireflux surgery. As of 2015, only 8 cases have been described in the dedicated literature. Migration of polypropylene mesh is even rare, as we know of only 2 descriptions. Herein we witness the third evidence of this extremely uncommon but serious disease. A 39-year-old woman presented with long-standing dysphagia. Twenty years before, she underwent laparotomic Nissen fundoplication and cruroplasty with a polypropylene mesh for gastroesophageal reflux disease (GERD) associated with a large hiatal hernia (LHH). At admission, gastroscopy and CT scan documented a partial transmural migration of the mesh resulting anchored to the gastric wall (Figure 1A-B). The mesh was removed through a laparotomy gastrotomy followed by simple Toupet fundoplication without crural closure. Ten months after the intervention, she keeps on being asymptomatic. Associating prosthetic cruroplasty with fundoplication has become the standard procedure for GERD with LHH: in fact, the use of mesh repair is associated with fewer recurrences than simple closure2. However, this intervention is not exempt from complications (less than 2%) such as fibrosis and stenosis of the hiatus3. Transmural migration of the mesh through the gastric or the esophageal wall is another specific but infrequent problem. As of 2015, only 2 and 8 cases have been described respectively for polypropylene and PTFE dual meshes1,4-6. The time span elapsed from the intervention to migration varies from a month to several years, and it is irrespective of the prosthetic material4-6. Of interest, a complete migration of the employed mesh is more auspicable than a partial one: in the former event, the mesh can be retrieved by gastroscopy or even naturally expelled, while in the latter surgery becomes imperative1,6. The introduction of bioabsorbable materials could markedly reduce the occurrence of this kind of complication6.