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Is it meaningful to add mesh reinforcement to laparoscopic fundoplication for esophageal hiatal hernias in the patients with high risk of hiatal hernia recurrence?

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Abstract

Background

While laparoscopic fundoplication is a standard surgical procedure for patients with esophageal hiatal hernias, the postoperative recurrence of esophageal hiatal hernias is a problem for patients with giant hernias, elderly patients, or obese patients. Although there are some reports indicating that reinforcement with mesh is effective, there are differing opinions regarding the use thereof. The aim of this study is to investigate whether mesh reinforcement is effective for laparoscopic fundoplication in patients with esophageal hiatus hernias.

Methods

The subjects included 280 patients who underwent laparoscopic fundoplication as the initial surgery for giant esophageal hiatal hernias, elderly patients aged 75 years or older, and obese patients with a BMI of 28 or higher, who were considered at risk of recurrent hiatal hernias based on the previous reports. Of the subject patients, 91 cases without mesh and 86 cases following the stabilization of mesh use were extracted to compare the postoperative course including the pathology, symptom scores, surgical outcome, and recurrence of esophageal hiatus hernias.

Results

The preoperative conditions indicated that the degree of esophageal hiatal hernias was high in the mesh group (p = 0.0001), while the preoperative symptoms indicated that the score of heartburn was high in the non-mesh group (p = 0.0287). Although the surgical results indicated that the mesh group underwent a longer operation time (p < 0.0001) and a higher frequency of intraoperative complications (p = 0.037), the rate of recurrence of esophageal hiatal hernia was significantly low (p = 0.049), with the rate of postoperative reflux esophagitis also tending to be low (p = 0.083).

Conclusions

Mesh reinforcement in laparoscopic fundoplication for esophageal hiatal hernias contributes to preventing the recurrence of esophageal hiatal hernias when it comes to patient options based on these criteria.

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Data availability

The data are available from the corresponding author on reasonable request.

Abbreviations

LF:

Laparoscopic fundoplication

BMI:

Body mass index

MII-pH:

Multichannel intraluminal impedance with pH monitoring

OL:

Overall length

AL:

Abdominal length

LESP:

Lower esophageal sphincter pressure

IQR:

Interquartile ranges

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Authors and Affiliations

  1. Department of Surgery, Fuji City General Hospital, 50, Takashima-Cho, Fuji, Shizuoka, 416-0951, Japan

    Kazuto Tsuboi

  2. Department of Surgery, Nishisaitama-Chuo National Hospital, Saitama, Japan

    Nobuo Omura

  3. Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan

    Kazuto Tsuboi, Takahiro Masuda, Nobuo Omura, Masato Hoshino, Se-Ryung Yamamoto, Shunsuke Akimoto, Yuki Sakashita, Naoko Fukushima, Hideyuki Takeuchi, Keita Takahashi, Fumiaki Yano & Ken Eto

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  1. Kazuto Tsuboi
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Contributions

KT analyzed data and wrote the manuscript. FY and NO supervised the study and critically revised the manuscript. TM, FY, NO, MH, S-RY, SA, YS, NF, HT and KT collected data. KE critically revised the manuscript.

Corresponding author

Correspondence to Kazuto Tsuboi.

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Ethical Statement

The protocol of this study has been approved by the Jikei University School of Medicine Institutional Review Board [30–304(9325)]. All informed consent was obtained from the subjects and guardians.

Conflict of interest

Drs. Tsuboi, Masuda, Omura, Hoshino, Yamamoto, Akimoto, Sakashita, Fukushima, Takeuchi, Takahashi, Yano and Eto have no conflicts of interest or financial ties to disclose.

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Tsuboi, K., Masuda, T., Omura, N. et al. Is it meaningful to add mesh reinforcement to laparoscopic fundoplication for esophageal hiatal hernias in the patients with high risk of hiatal hernia recurrence?. Esophagus 21, 67–75 (2024). https://doi.org/10.1007/s10388-023-01026-8

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  • DOI: https://doi.org/10.1007/s10388-023-01026-8

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