‘Mesh hiatal hernioplasty’ versus ‘suture cruroplasty’ in laparoscopic para-oesophageal hernia surgery; a systematic review and meta-analysis

Sathasivam, R.; Gopinath, Bussa; Viswanath, Y. K. S.; Gill, Talvinder; Reddy, A Suyodhan; Shanmugam, V. U.; Gilliam, A. D.; Thambi, Prem

doi:10.1016/j.asjsur.2018.05.001

Cited by 51 publications

(41 citation statements)

References 17 publications

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“…Prior studies have demonstrated decreased recurrence rates of PEH with the use of mesh. 23 As the NSQIP does not provide a long-term follow-up, recurrence rates with the utilization of mesh were unable to be evaluated or analyzed in the present study.…”

Section: Discussionmentioning

confidence: 98%

Predictors of Morbidity and Mortality in Complex Paraesophageal Hernia Repair: A NSQIP Analysis

Dubina

Moazzez

Park

et al. 2019

The American Surgeon

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Paraesophageal hernia (PEH) repair is typically performed electively. Complex PEHs (obstructed or gangrenous) require more urgent repair and can have significant complications. Although elective repair is primarily laparoscopic, limited data are available on the use of laparoscopy for complex cases. Patients undergoing complex PEH repair were identified from the NSQIP database, and predictors of morbidity and mortality were compared for 2473 laparoscopic and 861 open repairs. Compared with the laparoscopic approach, emergent surgeries (36.7% vs 10.8%, P < 0.001) and preoperative sepsis (22.9% vs 7.4%, P < 0.001) were more common in the open group. Operative times were shorter for open repairs (152.6 vs 172.2 minutes, P = 0.03). However, open repair was associated with increased morbidity (28.2% vs 11%, P < 0.001) and mortality (5.2% vs 1.4%, P < 0.001), likely because of higher rates of preoperative comorbidities in the open group. On multivariable regression analysis, preoperative sepsis was associated with increased mortality and morbidity, whereas laparoscopic repair was associated with decreased morbidity. If laparoscopic repair can be safely completed, it is associated with decreased morbidity, despite longer operative times.

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Section: Discussionmentioning

confidence: 98%

Predictors of Morbidity and Mortality in Complex Paraesophageal Hernia Repair: A NSQIP Analysis

Dubina

Moazzez

Park

et al. 2019

The American Surgeon

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“…The advantage of mesh reinforcement of cruroplasty during HH repairs remains a controversial subject in the literature due to the lack of consensus definitions of outcomes such as recurrence and complication. Several recent meta-analyses and literature reviews have varying results, with some finding no difference in outcomes (reoperation and complication rates) comparing mesh to suture reinforcement 9,20,21 , but also finding a significant reduction in hernia recurrence with the use of mesh 20,22,23 . Furthermore, studies have also compared the efficacy of biologic versus synthetic mesh.…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes in Patients Undergoing Paraesophageal Hiatal Hernia Repair

Howell

Liu

Petrone

et al. 2020

Sci Rep

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Many patients with hiatal hernias (HH) are asymptomatic; however, symptoms may include heartburn, regurgitation, dysphagia, nausea, or vague epigastric pain depending on the hernia type and severity. the ideal technique and timing of repair remains controversial. this report describes short-term outcomes and readmissions of patients undergoing HH repair at our institution. All patients who underwent HH repair from January 2012 through April 2017 were reviewed. Patients undergoing concomitant bariatric surgery were excluded. 239 patients were identified and 128 were included. Eighty-eight were female (69%) and 40 were male (31%) with a mean age of 59 years (range 20-91 years) and a mean BMI of 29.2 kg/m 2 (17-42). Worsening GERD was the most common presenting symptom in 79 (61.7%) patients. Eighty-four laparoscopic cases (65.6%) and 44 robotic assisted (34.4%) procedures were performed. Mesh was used in 59 operations (3 polytetrafluoroethylene; 56 biologic). All hiatal hernia types (I-IV) were collected. Majority were initial operations (89%). Techniques included: Toupet fundoplication in 68 cases (63.0%), Nissen fundoplication in 36 (33.3%), Dor fundoplication in 4 (3.7%), concomitant Collis gastroplasty in 4 (3.1%), and primary suture repair in 20 (15.6%). Outcomes between robotic and laparoscopic procedures were compared. Length of stay was reported as median and interquartile range for laparoscopic and robotic: 1.0 day (1.0-3.0) and 2.0 days (1.0-2.5); p = 0.483. Thirty-day readmission occurred in 9 patients, 7 (8.3%) laparoscopic and 2 (4.6%) robotic; p = 0.718. Two 30-day reoperations occurred, both laparoscopic; p = 0.545. Total of 16 complications occurred; 18.6% had a complication with the use of mesh compared to 8.7% without the use of mesh, p = 0.063. there were no conversion to open modality and no mortalities were reported. Hiatal hernia repair can be performed safely with a low incidence of complications.

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“…Several meta-analyses described a significant reduction in the recurrence rate at medium-term follow-up, including a lower risk of surgical revision, with the use of prosthetic materials, but the quality of analyzed data was poor and therefore the results are of limited level of evidence [44,45] . For instance, Tam et al [46] performed in 2016 a systematic review and meta-analysis of studies assessing the comparison between primary repair and the use of synthetic mesh.…”

Section: Peh Sac Excisionmentioning

confidence: 99%

Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

Ugliono¹,

Rebecchi²,

Seno³

et al. 2021

Mini-invasive Surg

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Paraesophageal Hernia (PEH) is the protrusion of the stomach and/or other abdominal viscera into the mediastinum due to an enlargement of the diaphragmatic hiatus. The treatment of PEH is challenging: On the one hand, watchful waiting carries the risk of developing acute life-threatening complications requiring an emergency operation. On the other hand, elective repair of PEH has non-negligible morbidity and mortality rates, also due to the characteristics of PEH affected patients, who are generally elder and frail. A review of the literature is presented to highlight strategies that can be adopted to minimize early and long-term complications after PEH surgical repair. The laparoscopic approach has been shown to provide reduced hospital stay, postoperative morbidity and mortality, and overall costs compared to traditional open surgery, and it is currently considered the standard approach both to elective and emergency operations. The evidence suggests that strict adherence to surgical principles, such as hernia sac excision, extended mediastinal dissection of the esophagus, and tension-free crural repair with or without mesh are mandatory to achieve optimal surgical outcomes and reduce PEH recurrence rate. Different shapes, materials, and techniques of prosthetic repair and the use of relaxing incisions have been proposed, but long-term data are lacking, and no conclusions can be drawn regarding the ideal method of crural closure. When a short esophagus is recognized despite extensive mediastinal dissection, esophageal lengthening procedures are indicated. Systematic addition of a fundoplication is strongly encouraged, for either treating gastroesophageal reflux or reducing recurrence rate.

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‘Mesh hiatal hernioplasty’ versus ‘suture cruroplasty’ in laparoscopic para-oesophageal hernia surgery; a systematic review and meta-analysis

Cited by 51 publications

References 17 publications

Predictors of Morbidity and Mortality in Complex Paraesophageal Hernia Repair: A NSQIP Analysis

Predictors of Morbidity and Mortality in Complex Paraesophageal Hernia Repair: A NSQIP Analysis

Short-Term Outcomes in Patients Undergoing Paraesophageal Hiatal Hernia Repair

Large hiatal hernia: minimizing early and long-term complications after minimally invasive repair

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