Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis

Clapp, Benjamin; Kara, Ali M.; Nguyen-Lee, Paul J.; Annabi, Hani Michael; Alvarado, Luis; Marr, John D.; Ghanem, Omar M.; Davis, Brian R.

doi:10.1007/s00464-022-09514-1

Cited by 9 publications

(4 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The bio-absorbable mesh however was placed posterior to the esophagus in a U-shape instead of circular around the esophagus. Nonetheless, studies were reported to be very heterogenous, leading to the authors pleading for further studies investigating the long-term outcomes while accounting for various factors such as hernia classification, surgical technique and post-operative outcomes [ 23 ]. Further research is needed before the biological mesh is ruled a success since too little evidence is available at this moment.…”

Section: Discussionmentioning

confidence: 99%

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia

Geerts,

de Haas,

Nieuwenhuijs

2024

Surg Endosc

View full text Add to dashboard Cite

Background Hiatal Hernia (HH) is a common structural defect of the diaphragm. Laparoscopic repair with suturing of the hiatal pillars followed by fundoplication has become standard practice. In an attempt to lower HH recurrence rates, mesh reinforcement, commonly located at the posterior site of the esophageal hiatus, has been used. However, effectiveness of posterior mesh augmentation is still up to debate. There is a lack of understanding of the mechanism of recurrence requiring further investigation. We investigated the anatomic location of HH recurrences in an attempt to assess why HH recurrence rates remain high despite various attempts with mesh reinforcement. Methods A retrospective case series of prospectively collected data from patients with hiatal hernia repair between 2012 and 2020 was performed. In total, 54 patients with a recurrent hiatal hernia operation were included in the study. Video clips from the revision procedure were analyzed by a surgical registrar and senior surgeon to assess the anatomic location of recurrent HH. For the assessment, the esophageal hiatus was divided into four equal quadrants. Additionally, patient demographics, hiatal hernia characteristics, and operation details were collected and analyzed. Results 54 patients were included. The median time between primary repair and revision procedure was 25 months (IQR 13–95, range 0–250). The left-anterior quadrant was involved in 43 patients (80%), the right-anterior quadrant in 21 patients (39%), the left-posterior quadrant in 21 patients (39%), and the right-posterior quadrant in 10 patients (19%). Conclusion In this study, hiatal hernia recurrences occured most commonly at the left-anterior quadrant of the hiatus, however, posterior recurrences were not uncommon. Based on our results, we hypothesize that both posterior and anterior hiatal reinforcement might be a suitable solution to lower the recurrence rate of hiatal hernia. A randomized controlled trial using a circular, bio-absorbable mesh has been initiated to test our hypothesis.

show abstract

Section: Discussionmentioning

confidence: 99%

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia

Geerts,

de Haas,

Nieuwenhuijs

2024

Surg Endosc

View full text Add to dashboard Cite

show abstract

“…Prospective and randomized studies in the literature have conflicting results on reducing recurrences using prostheses to reinforce hiatoplasty. A major limitation is that the few randomized studies analyzed different types of meshes, varying in relation to the material (polypropylene, PTFE, biological, absorbable synthetic), shape (U-, C-, rectangular, circumferential), size (1x3 cm, 3x4 cm), fixation methods (points, staples, glues), and application position (anterior or posterior to the esophagus), in addition to having different definitions as to what large hernias would be 11 , 12 , 30 , 40 .…”

Section: Considerations On Surgical Techniquementioning

confidence: 99%

“…A recent meta-analysis, comparing synthetic absorbable meshes to no mesh, reported a significantly lower recurrence rate than the non-mesh group (8 vs. 18%; 95%CI 0.08−0.17). Long-term results of these types of mesh are still unknown 11 .…”

Section: Considerations On Surgical Techniquementioning

confidence: 99%

Brazilian Hernia and Abdominal Wall Society Statement on Large Hiatal Hernias Management

BRANDALISE,

HERBELLA,

LUNA

et al. 2023

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

Large hiatal hernias, besides being more prevalent in the elderly, have a different clinical presentation: less reflux, more mechanical symptoms, and a greater possibility of acute, life-threatening complications such as gastric volvulus, ischemia, and visceral mediastinal perforation. Thus, surgical indications are distinct from gastroesophageal reflux disease-related sliding hiatal hernias. Heartburn tends to be less intense, while symptoms of chest pain, cough, discomfort, and tiredness are reported more frequently. Complaints of vomiting and dysphagia may suggest the presence of associated gastric volvulus. Signs of iron deficiency and anemia are found. Surgical indication is still controversial and was previously based on high mortality reported in emergency surgeries for gastric volvulus. Postoperative mortality is especially related to three factors: body mass index above 35, age over 70 years, and the presence of comorbidities. Minimally invasive elective surgery should be offered to symptomatic individuals with good or reasonable performance status, regardless of age group. In asymptomatic and oligosymptomatic patients, besides obviously identifying the patient’s desire, a case-by-case analysis of surgical risk factors such as age, obesity, and comorbidities should be taken into consideration. Attention should also be paid to situations with greater technical difficulty and risks of acute migration due to increased abdominal pressure (abdominoplasty, manual labor, spastic diseases). Technical alternatives such as partial fundoplication and anterior gastropexy can be considered. We emphasize the importance of performing surgical procedures in cases of large hiatal hernias in high-volume centers, with experienced surgeons.

show abstract

“…Similar results were reported by Temperly et al in a meta-analysis of RCTs, stating that non-absorbable mesh-augmented HH repair resulted in a lower recurrence rate compared to the suture repair [ 47 ]. Clapp et al report in a meta-analysis of RCTs and non-RCTs as well in favor of a lower recurrence rate after bioabsorbable mesh augmented HH repair compared to the suture alone HH repair [ 48 ].…”

Section: Mesh Augmentationmentioning

confidence: 99%

Evidence mapping on how to perform an optimal surgical repair of large hiatal hernias

Nickel,

Müller,

Cizmic

et al. 2023

Langenbecks Arch Surg

View full text Add to dashboard Cite

Background Symptomatic and large hiatal hernia (HH) is a common disorder requiring surgical management. However, there is a lack of systematic, evidence-based recommendations summarizing recent reviews on surgical treatment of symptomatic HH. Therefore, this systematic review aimed to create evidence mapping on the key technical issues of HH repair based on the highest available evidence. Methods A systematic review identified studies on eight key issues of large symptomatic HH repair. The literature was screened for the highest level of evidence (LE from level 1 to 5) according to the Oxford Center for evidence-based medicine’s scale. For each topic, only studies of the highest available level of evidence were considered. Results Out of the 28.783 studies matching the keyword algorithm, 47 were considered. The following recommendations could be deduced: minimally invasive surgery is the recommended approach (LE 1a); a complete hernia sac dissection should be considered (LE 3b); extensive division of short gastric vessels cannot be recommended; however, limited dissection of the most upper vessels may be helpful for a floppy fundoplication (LE 1a); vagus nerve should be preserved (LE 3b); a dorso-ventral cruroplasty is recommended (LE 1b); routine fundoplication should be considered to prevent postoperative gastroesophageal reflux (LE 2b); posterior partial fundoplication should be favored over other forms of fundoplication (LE 1a); mesh augmentation is indicated in large HH with paraesophageal involvement (LE 1a). Conclusion The current evidence mapping is a reasonable instrument based on the best evidence available to guide surgeons in determining optimal symptomatic and large HH repair.

show abstract

Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis

Cited by 9 publications

References 40 publications

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia

Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia

Brazilian Hernia and Abdominal Wall Society Statement on Large Hiatal Hernias Management

Evidence mapping on how to perform an optimal surgical repair of large hiatal hernias

Contact Info

Product

Resources

About