Routine use of mesh during hiatal closure is safe with no increase in adverse sequelae
Hiatal hernia; Surgery, complications; Surgery/incisions/exposure/techniques
© 2017, Springer Science+Business Media, LLC. Background: Primary laparoscopic hiatal repair with fundoplication is associated with a high recurrence rate. We wanted to evaluate the potential risks posed by routine use of onlay-mesh during hiatal closure, when compared to primary repair. Methods: Utilizing single-institutional database, we identified patients who underwent primary laparoscopic hiatal repair from January 2005 through December 2014. Retrospective chart review was performed to determine perioperative morbidity and mortality. Long-term results were assessed by sending out a questionnaire. Results were tabulated and patients were divided into 2 groups: fundoplication with hiatal closure + absorbable or non-absorbable mesh and fundoplication with hiatal closure alone. Results: A total of 505 patients underwent primary laparoscopic fundoplication. Mesh reinforcement was used in 270 patients (53.5%). There was no significant difference in the 30-day perioperative outcomes between the 2 groups. No clinically apparent erosions were noted and no mesh required removal. Standard questionnaire was sent to 475 patients; 174 (36.6%) patients responded with a median follow-up of 4.29 years. Once again, no difference was noted between the 2 groups in terms of dysphagia, heartburn, long-term antacid use, or patient satisfaction. Of these, 15 patients (16.9%, 15/89) in the ‘Mesh’ cohort had symptomatic recurrence as compared to 19 patients (22.4%, 19/85) in the ‘No Mesh’ cohort (p = 0.362). A reoperation was necessary in 6 patients (6.7%) in the ‘Mesh’ cohort as compared to 3 patients (3.5%) in the ‘No Mesh’ cohort (p = 0.543). Conclusions: Onlay-mesh use in laparoscopic hiatal repair with fundoplication is safe and has similar short and long-term results as primary repair.
Abu Saleh, W., Morris, L., Tariq, N., Kim, M., Chan, E., Meisenbach, L., Dunkin, B., Sherman, V., Rosenberg, W., Bass, B., Graviss, E., Nguyen, D., Reardon, P., & Khaitan, P. (2018). Routine use of mesh during hiatal closure is safe with no increase in adverse sequelae. Surgical Endoscopy, 32 (2). http://dx.doi.org/10.1007/s00464-017-5758-8