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Hiatal hernia repair with biosynthetic mesh reinforcement: a qualitative systematic review

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Abstract

Introduction

Reinforcement of crural closure with synthetic resorbable mesh has been proposed to decrease recurrence rates after hiatal hernia repair, but continues to be controversial. This systematic review aims to evaluate the safety, efficacy, and intermediate-term results of using biosynthetic mesh to augment the hiatus.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed throughout this systematic review. The Risk of Bias in Non-Randomized Studies of Interventions and Risk of Bias in Randomized Trials tools were used to perform qualitative assessment of all studies included in this review. Recommendations were then summarized for the following pre-defined key items: protocol, research question, search strategy, study eligibility, data extraction, study design, risk of bias, publication bias, and statistical analysis.

Results

The systematic literature search found 520 articles, 101 of which were duplicates and 355 articles were determined to be unrelated to our study and excluded. The full text of the remaining 64 articles was thoroughly assessed. A total of 18 articles (1846 patients) were ultimately included for this review, describing hiatal hernia repair using three different biosynthetic meshes—BIO-A, Phasix ST, and polyglactin mesh. Mean operative time varied from 127 to 223 min. Mean follow up varied from 12 to 54 months. There were no mesh erosions or explants. One mesh-related complication of stenosis requiring reoperation was reported with BIO-A. Studies showed significant improvement in symptom and quality-of-life scores, as well as satisfaction with surgery. Recurrence was reported as radiologic or clinical recurrence. Overall, recurrence rate varied from 0.9 to 25%.

Conclusion

The use of biosynthetic mesh is safe and effective for hiatal hernia repair with low complications rates and high symptom resolution. The reported recurrence rates are highly variable due to significant heterogeneity in defining and evaluating recurrences. Further randomized controlled trials with larger samples and long-term follow-up should be performed to better analyze outcomes and recurrence rates.

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Funding

There was no funding for this study.

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Authors and Affiliations

  1. Montefiore Medical Center, The Bronx, NY, USA

    Diego L. Lima, Felipe R. Murillo & Prashanth Sreeramoju

  2. University of Texas Medical Branch, Galveston, TX, USA

    Sergio Mazzola Poli de Figueiredo

  3. NYU Langone Health, New York, NY, USA

    Xavier Pereira, Flavio Malcher & Tanuja Damani

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  1. Diego L. Lima
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  2. Sergio Mazzola Poli de Figueiredo
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  3. Xavier Pereira
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  4. Felipe R. Murillo
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  5. Prashanth Sreeramoju
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  6. Flavio Malcher
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Correspondence to Diego L. Lima.

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Disclosures

Flavio Malcher discloses consulting fees from BD, Intuitive, Integra, DeepBlue, Allergan & Medtronic, outside the submitted study. Tanuja Damani discloses—proctor, speaker and advisory board for Intuitive Surgical, and speaker for Becton Dickinson. Diego L. Lima, Xavier Pereira, Sergio Mazzola Poli de Figueiredo, Felipe R. Murillo, Prashanth Sreeramoju have no conflicts of interest or financial ties to disclose.

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Lima, D.L., de Figueiredo, S.M.P., Pereira, X. et al. Hiatal hernia repair with biosynthetic mesh reinforcement: a qualitative systematic review. Surg Endosc 37, 7425–7436 (2023). https://doi.org/10.1007/s00464-023-10379-1

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  • DOI: https://doi.org/10.1007/s00464-023-10379-1

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