Sutured Versus Mesh-augmented Hiatus Hernia Repair

Abstract

Objective: This meta-analysis systematically reviewed published randomized control trials comparing sutured versus mesh-augmented hiatus hernia (HH) repair. Our primary endpoint was HH recurrence at short- and long-term follow-up. Secondary endpoints were: surgical complications, operative times, dysphagia and quality of life. Summary Background Data: Repair of large HHs is increasingly being performed. However, there is no consensus for the optimal technique for hiatal closure between sutured versus mesh-augmented (absorbable or nonabsorbable) repair. Methods: A systematic review of Medline, Scopus (which encompassed Embase), Cochrane Central Register of Controlled Trials, Web of Science, and PubMed was performed to identify relevant studies comparing mesh-augmented versus sutured HH repair. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. Results: Seven randomized control trials were found which compared mesh-augmented (nonabsorbable mesh: n = 296; absorbable mesh: n = 92) with sutured repair (n = 347). There were no significant differences for short-term hernia recurrence (defined as 6–12 months, 10.1% mesh vs 15.5% sutured, P = 0.22), long-term hernia recurrence (defined as 3–5 years, 30.7% mesh vs 31.3% sutured, P = 0.69), functional outcomes and patient satisfaction. The only statistically significant difference was that the mesh repair required a longer operation time (P = 0.05, OR 2.33, 95% confidence interval 0.03–24.69). Conclusions: Mesh repair for HH does not offer any advantage over sutured hiatal closure. As both techniques deliver good and comparable clinical outcomes, a suture only technique is still an appropriate approach.

Hiatal Hernia Repair With Tension-Free Mesh or Crural Sutures Alone in Antireflux Surgery

“…The overall rate of 34% of hiatal hernia recurrence for both groups at 13 years after the operation might be considered high, but other randomized trials with long-term follow-up have shown similar or even higher rates . Likewise, in a recent meta-analysis of randomized clinical trials with long-term follow-up, 30.7% and 31.3% recurrence rates were reported after mesh augmentation and after suture repair only, respectively . Most information regarding durability of hiatal hernia repair emanates from studies of patients with large paraesophageal hiatal hernias.…”

“…Early randomized trials with short-term outcomes reported lower rates of hiatal hernia recurrence in patients with mesh reinforcement compared with crural closure using sutures only . However, more recent studies with longer follow-up did not show significant differences . Moreover, the use of mesh in the hiatal orifice carries the risk of serious complications, such as esophageal stenosis, mesh erosion, or fibrosis, leading to persistent dysphagia or pain …”

A trans‐Canadian positive deviance seminar for paraesophageal hernia surgery: Reporting national postoperative outcomes and consensus recommendations

“…8 Finally, some surgeons routinely use mesh to buttress the crural closure as mesh may decrease the incidence of early recurrence at cost of increased rates of early dysphagia and no decrease in the incidence of long-term recurrence. [9][10][11][12][13] Approaches toward postoperative care including discharge also vary. Same day discharge has been found to be both feasible and safe with an associated decrease in hospital costs.…”

Mesh and Hiatal Hernia Repair—The Never-Ending Saga

“…Some aspects of this article deserve comments. Most of the studies mentioned in the discussion evaluated the use of mesh for the repair of large paraesophageal hernias, a different disease and a more complex operation, whereas in this study, only patients mostly with small sliding hernias were included . In addition, only 40% of the original patients were assessed for hiatal hernia recurrence at the long-term follow-up.…”

“…Analatos and colleagues must be congratulated for this long-term follow-up study that shows that mesh repair did not reduce hernia recurrence when compared with suture repair of hiatal hernias. This study confirms the results of many other studies that have shown that a cruroplasty with sutures is as effective as a cruroplasty reinforced by either absorbable or nonabsorbable mesh …”