Hiatus hernia, Mesh repair, Laparoscopy, Randomized controlled trial.
Trial registration -This trial is registered with the Australia and New Zealand ClinicalTrials Registry ACTRN12605000725662 Determine whether absorbable or non-absorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared to suture repair.
Summary Background Data:Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has been recommended. Previous trials have shown less short term recurrence with mesh, but adverse outcomes limit mesh use.
Methods:Multicentre prospective double blind randomized controlled trial of 3 methods of repair; sutures vs. absorbable mesh vs. non-absorbable mesh. Primary outcome -hernia recurrence assessed by barium meal X-ray and endoscopy at 6 months. Secondary outcomes -clinical symptom scores at 1, 3, 6 and 12 months.
Results:126 patients enrolled -43 sutures, 41 absorbable mesh and 42 non-absorbable mesh. 96.0%were followed to 12 months, with objective follow-up data in 92.9%. A recurrent hernia (any size) was identified in 23.1% following suture repair, 30.8% -absorbable mesh, and 12.8%
Objective:
To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair.
Summary of Background Data:
Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair.
Methods:
Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome – hernia recurrence assessed by barium meal X-ray and endoscopy at 3–4 years. Secondary outcomes – clinical symptom scores at 2, 3, and 5 years.
Results:
126 patients were enrolled – 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% – absorbable mesh, and 42.9% – nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh.
Conclusions:
No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.
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