Laparoscopic treatment of giant hiatal hernia with or without mesh reinforcement: A systematic review and meta-analysis

Campos, Vjm; Palacio, Danica; Glina, Felipe Placco Araújo; Tustumi, Francisco; Bernardo, Wanderlei M.; Sousa, Alexandre Venâncio de

doi:10.1016/j.ijsu.2020.02.036

Cited by 41 publications

(32 citation statements)

References 23 publications

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“…Dara et al 19 reported that the recurrence rate was 22% and the median time to relapse was 12 months, which supported our recurrence rate. At present, however, MR for preventing recurrence is still unclear, 20 and even in a meta‐analysis, no statistically significant difference was observed with or without MR 21 . However, some reports state that the recurrence rate decreases when MR is added 1 .…”

Section: Discussionmentioning

confidence: 96%

Treatment strategy for laparoscopic hiatal hernia repair

Yano

Tsuboi

Omura

et al. 2021

Asian J Endoscop Surgery

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Introduction According to the anatomy‐function‐pathology classification, the recurrence rates of A2 and A3 hiatal hernia (HH) after laparoscopic fundoplication are higher than the rate of A1 HH. Therefore, we introduced mesh reinforcement for A2 and A3 cases. In addition, gastropexy was added to A3 cases. We present the strategy for HH repair. Methods In all, 537 patients (mean age 55.4 ± 16.7 years, 219 women) who underwent primary laparoscopic fundoplication for HH from January 1995 to October 2019 were included. They were divided into three groups by A factor (A1:A2:A3 = 296:156:85). Their clinical data were collected in a prospective fashion and retrospectively reviewed. Results The median age (years) of the patients in each group was A1:A2:A3 = 46:63:74 years, and age was directly proportional to the size of HH (P < 0.0001). The proportion of females was significantly higher in A3 than in other classes (P < 0.0001). Preoperative reflux esophagitis was severe in A2 (P < 0.0001) and operation time (min) was directly proportional to HH size (A1:A2:A3 = 135:167:193, P < 0.0001). The recurrence rate of conventional laparoscopic fundoplication was 15% (46/304), and it was higher for A2 and A3 than for A1 (P = 0.027). However, with reinforcement of the hiatus using a mesh and gastropexy, the recurrence rates decreased. Conclusion Combining mesh reinforcement and gastropexy may reduce the recurrence rate of para‐ and mixed‐type HH.

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Section: Discussionmentioning

confidence: 96%

Treatment strategy for laparoscopic hiatal hernia repair

Yano

Tsuboi

Omura

et al. 2021

Asian J Endoscop Surgery

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“…One hundred eighty-two patients that underwent primary suture repair were also analysed, and 50 recurrences (27.4%) were found. In another meta-analysis of Campos et al [15], no evidence was found that routine mesh reinforcement in laparoscopic repair of giant PEH decreases recurrences, compared to suture repair ( p = 0.12). Finally, the study by Watson et al [16] also suggests that mesh reinforcement does not significantly reduce recurrence rates.…”

Section: Discussionmentioning

confidence: 99%

Use of Polypropylene Strips for Reinforcement of the Cruroplasty in Laparoscopic Paraesophageal Hernia Repair: A Retrospective Cohort Study

Dop¹,

Smet²,

Mamound³

et al. 2021

Dig Surg

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Introduction: Laparoscopic paraesophageal hernia repair is an effective treatment for symptomatic paraesophageal hernias. To reduce recurrence rates, the use of prosthetics for the crural repair has been suggested. Mesh-related complications are rare but known to be disastrous. To address another form of crural repair, polypropylene strips are suggested. This study aimed to assess peri- and postoperative complications of reinforcement of cruroplasty with polypropylene strips. Methods: From 2013 to 2020, patients with a primary or recurrent type 2, 3, or 4 paraesophageal hernia that underwent cruroplasty with polypropylene strips were retrospectively reviewed. Intra- and postoperative complications were graded according to the Clavien-Dindo classification. The incidence of symptomatic recurrent hiatal hernia (CT or endoscopy proven) and hospital stay were assessed. Results: One hundred fifty-eight patients were included. Mean age was 65 years (standard deviation 10.4), and 119 patients were female (75.3%). Almost 50% of surgeries took place between 2018 and 2020. Median follow-up was 7 months (interquartile range 17.5). Mean operation time in the primary hernia group was 159 min (standard deviation 39.0), and length of stay was 4.4 days. In 3/158 patients (2.0%), intraoperative complications occurred. Two patients developed a grade 4 and seven patients a grade 3 postoperative complication. No mortality was recorded. Twelve recurrences (8.2%) were detected in the primary hernia group and one (9.1%) in the recurrent hernia group. Conclusion: There were no mesh-related complications seen and symptomatic recurrence rate was low, but longer follow-up is needed.

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“…Meta-analysis of these 5 RCTs found that need for reoperation was significantly higher with suture-only repair (OR = 3.26), but there was no significant difference in hernia recurrence (OR = 1.65) [17]. Recent meta-analysis, including RCTs and 2 cohort studies of high methodological quality, demonstrated no benefit of mesh cruroplasty over suture repair and identified substantial heterogeneity between studies [32]. Inclusion of observational studies in two slightly older meta-analyses hinted at lower short-term recurrences with mesh repair but long-term outcomes were lacking, and these studies are at a greater risk of selection and detection bias [16,33].…”

Section: Discussionmentioning

confidence: 99%

Protocol for Randomised Controlled Feasibility Study Comparing Cruroplasty with Circumferential DynaMesh-HIATUS® Versus Suture-Only Repair for Large Hiatus Hernias

Darbyshire

Mátyus

Fogg

et al. 2020

SN Compr. Clin. Med.

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Laparoscopic fundoplication has become a standard surgical treatment for gastro-oesophageal reflux disease. Many of these patients also have a hiatus hernia that is repaired at the same time. However, suture-only repair of larger hiatus hernias has recurrence rates as high as 50%. Evidence on the effectiveness and safety of surgical mesh to reinforce hiatal repair compared with suture-only repair is currently lacking. This study aims to assess the feasibility of running a randomised controlled trial comparing the results of large hiatus hernia repair with DynaMesh-HIATUS® crural reinforcement versus standard suture repair alone. This is a single-centre, double-blind, parallel group randomised feasibility study. Forty patients with large hiatus hernia will be randomised to standard laparoscopic suture repair or suture repair with cruroplasty using the DynaMesh-HIATUS® circumferential mesh, with a 3-year follow-up period. Participants and assessors will be blinded to treatment allocation. Outcomes include trial process indicators (eligible participants, recruitment, and retention rates), surgical indicators (placement of mesh, operative complications, length of stay), adverse events, patient quality of life and symptom scores and mesh position after 1 year, and patient quality of life measures to 3 years. Feasibility will be assessed by rates of recruitment, retention, and successful surgical procedures. Clinical and patient-related outcomes for the two surgical methods will be described, and those most appropriate to include in a definitive trial identified. Correlation will be made between the position of the mesh on magnetic resonance imaging (MRI) and clinical outcomes. The DYNAMIC study will provide information to design and deliver a definitive randomised controlled trial of DynaMesh-HIATUS® cruroplasty compared with suture repair alone.

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Laparoscopic treatment of giant hiatal hernia with or without mesh reinforcement: A systematic review and meta-analysis

Cited by 41 publications

References 23 publications

Treatment strategy for laparoscopic hiatal hernia repair

Treatment strategy for laparoscopic hiatal hernia repair

Use of Polypropylene Strips for Reinforcement of the Cruroplasty in Laparoscopic Paraesophageal Hernia Repair: A Retrospective Cohort Study

Protocol for Randomised Controlled Feasibility Study Comparing Cruroplasty with Circumferential DynaMesh-HIATUS® Versus Suture-Only Repair for Large Hiatus Hernias

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