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Routine use of mesh during hiatal closure is safe with no increase in adverse sequelae

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Abstract

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.

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Acknowledgments

Deanna M. Conway and Elaine Jordan (helped with the mail-outs of the surveys and collecting them); Darrel Cleere (helped with the survey and uploading it onto MonkeySurvey).

Funding

Dyer and Baucum Fellowship (internal institutional funding).

Author information

Author notes

  1. Patrick Reardon and Puja G. Khaitan are senior co-authors and contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, University of Texas Health Science Center, San Antonio, TX, USA

    Walid K. Abu Saleh

  2. Department of General Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA

    Lee M. Morris, Nabil Tariq, Min P. Kim, Edward Y. Chan, Leonora M. Meisenbach, Brian J. Dunkin, Vadim Sherman, Wade Rosenberg, Barbara L. Bass, Patrick Reardon & Puja G. Khaitan

  3. Division of Thoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA

    Min P. Kim, Edward Y. Chan, Leonora M. Meisenbach & Puja G. Khaitan

  4. Department of Pathology and Genomic Medicine, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA

    Edward A. Graviss & Duc T. Nguyen

  5. Department of Surgery, Division of Thoracic Surgery, Houston Methodist Hospital, 6550 Fannin St., Smith Tower, Suite 1601, Houston, 77030, TX, USA

    Puja G. Khaitan

Authors
  1. Walid K. Abu Saleh
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Corresponding author

Correspondence to Puja G. Khaitan.

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Disclosures

Nabil Tariq has received honorarium from Gore; Min P. Kim has received honoraria from and is a consultant for Medtronic, Olympus, and Boston Scientific; Edward Y. Chan has received honoraria from Medtronic and Olympus; and Puja G. Khaitan has received honoraria from Boston Scientific. For the remaining authors, none were declared. Walid K. Abu Saleh, Lee M. Morris, Leonora M. Meisenbach, Brian J. Dunkin, Vadim Sherman, Wade Rosenberg, Barbara L. Bass, Edward A. Graviss, Duc T. Nguyen, and Patrick Reardon have no conflicts of interest or financial ties to disclose.

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Abu Saleh, W.K., Morris, L.M., Tariq, N. et al. Routine use of mesh during hiatal closure is safe with no increase in adverse sequelae. Surg Endosc 32, 879–888 (2018). https://doi.org/10.1007/s00464-017-5758-8

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  • DOI: https://doi.org/10.1007/s00464-017-5758-8

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