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Quality of Life Following Repair of Large Hiatal Hernia is Improved but not Influenced by Use of Mesh: Results From a Randomized Controlled Trial

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Abstract

Introduction

Laparoscopic surgery is the treatment of choice for repair of large hiatus hernia, but can be followed by recurrence. Repair with prosthetic mesh has been recommended to prevent recurrence, although complications following mesh repair have generated disagreement about whether or not mesh should be used. The early objective and clinical results of a randomized trial of repair with mesh versus sutures have been reported, and revealed few differences. In the current study, we evaluated quality of life outcomes within this trial at follow-up to 2 years.

Methods

In a multicenter prospective double-blind randomized trial three methods for repair of large hiatus hernia were compared: sutures versus repair with absorbable mesh (Surgisis) versus non-absorbable (Timesh). Quality of life assessment using the Short-Form 36 (SF-36) questionnaire was undertaken at 3, 6, 12 and 24 months after surgery. SF-36 outcomes (8 individual scales and 2 composite scales) were determined for each group, and compared between groups, and across different follow-up points.

Results

126 patients were enrolled—43 sutures, 41 absorbable mesh and 42 non-absorbable mesh. 115 (91.3 %) completed a preoperative questionnaire, and 113 (89.7 %) completed the post-operative questionnaire at 3 months, 116 (92.1 %) at 6 months, 114 (90.5 %) at 12 months, and 91 (72.2 %) at 24 months. The SF-36 Physical and Mental Component Scores (PCS and MCS) improved significantly following surgery, and this improvement was sustained across 24 months follow-up (p < 0.001 for PCS and MCS at each follow-up point). There were no significant differences between the groups for the component scores or the eight SF-36 subscale scores at each follow-up time. 29 individuals had a recurrence at 6 months follow-up, of which 9 were symptomatic. The PCS were higher in patients with recurrence versus without (p < 0.01), and in patients with a symptomatic recurrence versus asymptomatic recurrence versus no recurrence (p = 0.001).

Conclusion

SF-36 measured quality of life improved significantly after repair of large hiatal hernia at up to 2 years follow-up, and there were no differences in outcome for the different repair techniques. The use of mesh versus no mesh in repair of large hiatal hernia did not influence quality of life.

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Acknowledgments

This randomized trial was supported by Research Project Grants from the National Health and Medical Research Council (NHMRC) of Australia—Grant numbers 375111 and 1022722. We are grateful for the assistance of Ms Lorelle Smith, Ms Nicky Carney and Ms Lorraine Sheehan-Hennessy who contributed to data collection, and Drs Susan Gan and Philip Game who helped with enrolment of patients into the randomized trial. This trial is registered with the Australia and New Zealand Clinical Trials Registry ACTRN12605000725662.

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Authors and Affiliations

  1. Flinders University Department of Surgery, Room 3D211, Flinders Medical Centre, Bedford Park, SA, 5042, Australia

    Jan H. Koetje, Tanya Irvine & David I. Watson

  2. University of Adelaide Discipline of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia

    Sarah K. Thompson, Peter G. Devitt & Glyn G. Jamieson

  3. Cabrini Hospital, Malvern, VIC, Australia

    Simon D. Woods

  4. Department of Surgery, Austin Hospital, University of Melbourne, Heidelberg, VIC, Australia

    Ahmad Aly

Authors
  1. Jan H. Koetje
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  2. Tanya Irvine
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  3. Sarah K. Thompson
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  4. Peter G. Devitt
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  5. Simon D. Woods
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  6. Ahmad Aly
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  7. Glyn G. Jamieson
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  8. David I. Watson
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Correspondence to David I. Watson.

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Koetje, J.H., Irvine, T., Thompson, S.K. et al. Quality of Life Following Repair of Large Hiatal Hernia is Improved but not Influenced by Use of Mesh: Results From a Randomized Controlled Trial. World J Surg 39, 1465–1473 (2015). https://doi.org/10.1007/s00268-015-2970-3

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  • DOI: https://doi.org/10.1007/s00268-015-2970-3

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