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Primary repair of large hiatal defects is associated with higher than acceptable recurrence rates. This has led to the increased use of fascial prostheses for reinforcement of the hiatal repair. We report a case of intraluminal mesh erosion after repair of a recurrent paraesophageal hernia with a composite polytetrafluoroethylene/expanded polytetrafluoroethylene prosthesis in an 80-year-old woman. Mesh erosion is a rarely reported complication after hiatal hernia repair, and because many cases will go unreported, their true incidence is unknown. Besides the durability of mesh repair, the ongoing clinical trials investigating laparoscopic correction of hiatal hernias should also focus on the risk of complications associated with the use of prosthetic materials and the mode of fixation.