Skip to main content

Advertisement

Log in

Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Current literature is characterized by a discrepancy between reported symptomatic and radiological recurrent hiatal hernia’s following primary repair. Crural augmentation using mesh is suggested to reduce recurrence rates. The aim of this trial is to analyze 1-year outcome of laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh.

Methods

Between 2013 and 2016, 72 patients with an objectified hiatal hernia were randomized for primary repair using non-absorbable sutures and sutures reinforced with non-absorbable mesh. Data regarding the incidence of recurrent hiatal hernia, need for endoscopic dilatation or surgical reintervention, postoperative dysphagia and/or reflux symptoms, general health, and use of acid-suppressing medication were analyzed.

Results

72 patients (n = 36 vs. n = 36) were included. One year after primary repair and repair using non-absorbable mesh, there were no differences in the number of recurrent hiatal hernia’s demonstrated by barium swallow radiology (n = 4 [11.4%] vs. n = 6 [19.4%], p = 0.370) or upper gastrointestinal endoscopy (n = 5 [14.4%] vs. n = 5 [17.2%], p = 0.746), the number of surgical reinterventions (n = 2 [5.6%] vs. n = 1 [2.8%], p = 1.000), nor in chest pain and heartburn scores, with comparable dysphagia and satisfaction scores. Compared to the preoperative state, both groups demonstrated a comparable and significant reduction in chest pain score and Dakkak dysphagia score.

Conclusions

Use of non-absorbable mesh to reinforce primary hiatal hernia repair results in equal hiatal hernia recurrence and symptomatic outcome compared to repair using sutures alone. During 1-year follow-up, there were no mesh-related complications. Follow-up beyond 1 year needs to demonstrate whether these findings are sustained.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Kohn GP, Price RR, Demeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D (2013) Fanelli RD and the SAGED Guidelines Committee. Guidelines for the management of hiatal hernia—a SAGES guideline. http://www.sages.org/publications/guidelines/guidelines-for-the-managementof-hiatal-hernia. Accessed 15 Jun 2016

    Article  PubMed  Google Scholar 

  2. Engström C, Cai W, Irvine T, Devitt PG, Thompson SK, Game PA, Bessel JR, Jamieson GG, Watson DI (2012) Twenty years of experience with laparoscopic antireflux surgery. Br J Surg 99:1415–1421

    Article  PubMed  Google Scholar 

  3. Memon MA, Memon B, Yunus RM, Khan S (2016) Suture cruroplasty versus prosthetic hiatal herniorrhaphy for large hiatal hernia: a meta-analysis and systematic review of randomized controlled trials. Ann Surg 263:258–266

    Article  PubMed  Google Scholar 

  4. Aly A, Munt J, Jamieson GG, Ludemann R, Devitt PG, Watson DI (2005) Laparoscopic repair of large hiatal hernia. Br J Surg 92:648–653

    Article  CAS  PubMed  Google Scholar 

  5. Simons MP, Aufenacker T, Bay-Nislen M, Bouillot JL, Campanelli G, Conze J, de Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Miserez M (2009) European hernia society guidelines on the treatment of inguinal hernia adult patients. Hernia 13:343–403

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Mathes T, Walgenbach M, Siegel R (2016) Suture versus mesh repair in primary and incisional ventral hernias: a systematic review and meta-analysis. World J Surg 40:826–835

    Article  PubMed  Google Scholar 

  7. Frantzides CT, Carlson MA, Loizides S, Stavropoulos GP (2002) A prospective randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137:649–652

    Article  PubMed  Google Scholar 

  8. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481–490

    PubMed  PubMed Central  Google Scholar 

  9. Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213:461–468

    Article  PubMed  Google Scholar 

  10. Watson DI, Thompson SK, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG (2015) Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial. Ann Surg 261:282–289

    Article  PubMed  Google Scholar 

  11. Furnée EJ, Smith CD, Hazebroek EJ (2015) The use of mesh in laparoscopic large hiatal hernia repair: a survey of European surgeons. Surg Laparosc Endosc Percutan Tech 25(4):307–311

    Article  PubMed  Google Scholar 

  12. Oor JE, Koetje JH, Roks DJ, Nieuwenhuijs VB, Hazebroek EJ (2016) Laparoscopic hiatal hernia repair in the elderly patient. World J Surg 40:1404–1411

    Article  CAS  PubMed  Google Scholar 

  13. Neo EL, Zingg U, Devitt PG, Jamieson GG, Watson DI (2011) Learning curve for laparoscopic repair of very large hiatal hernia. Surg Endosc 25:1775–1782

    Article  PubMed  Google Scholar 

  14. Edye M, Salky B, Posner A, Fierer A (1998) Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia. Surg Endosc 12(10):1259–1263

    Article  CAS  PubMed  Google Scholar 

  15. Watson DI, Davies N, Devitt PG, Jamieson GG (1999) Importance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias. Arch Surg 134:1069–1073

    Article  CAS  PubMed  Google Scholar 

  16. Furnée EJ, Draaisma WA, Gooszen HG, Hazebroek EJ, Smout AJ, Broeders IA (2011) Tailored or routine addition of an antireflux fundoplication in laparoscopic large hiatal hernia repair: a comparative cohort study. World J Surg 35:78–84

    Article  PubMed  Google Scholar 

  17. Dakkak M, Bennett JR (1992) A new dysphagia score with objective validation. J Clin Gastroenterol 14:99–100

    Article  CAS  PubMed  Google Scholar 

  18. Rijnhart-De Jong HG, Draaisma WA, Smout AJ, Broeders IA, Gooszen HG (2008) The Visick score: a good measure for the overall effect of antireflux surgery? Scand J Gastroenterol 43:787 – 93

    Article  PubMed  Google Scholar 

  19. Hazebroek EJ, Leibman S, Smith GS (2009) Erosion of a composite PTFE/ePTFE mesh after hiatal hernia repair. Surg Laparosc Endosc Percutan Tech 19:175–177

    Article  PubMed  Google Scholar 

  20. Koetje JH, Oor JE, Roks DJ, Van Westreenen HL, Hazebroek EJ, Nieuwenhuijs VB (2017) Equal patient satisfaction, quality of life and objective recurrence rate after laparoscopic hiatal hernia repair with and without mesh. Surg Endosc. https://doi.org/10.1007/s00464-016-5405-9

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wang Z, Bright T, Irvine T, Thompson SK, Devitt PG, Watson DI (2015) Outcome for Asymptomatic Recurrence Following Laparoscopic Repair of Very Large Hiatus Hernia. J Gastrointest Surg 19:1385–1390

    Article  PubMed  Google Scholar 

  22. Roks DJ, Koetje JH, Oor JE, Broeders JA, Nieuwenhuijs VB, Hazebroek EJ (2017) Randomized clinical trial of 270° posterior versus 180° anterior partial laparoscopic fundoplication for gastro-oesophageal reflux disease. Br J Surg 104(7):843–851

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jelmer E. Oor.

Ethics declarations

Disclosure

Jelmer E. Oor, David J. Roks, Jan H. Koetje, Joris A. Broeders, Henderik L. van Westreenen, Vincent B. Nieuwenhuijs, and Eric J. Hazebroek have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oor, J.E., Roks, D.J., Koetje, J.H. et al. Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non-absorbable mesh. Surg Endosc 32, 4579–4589 (2018). https://doi.org/10.1007/s00464-018-6211-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6211-3

Keywords

Navigation