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Laparoscopic augmentation of the diaphragmatic hiatus with biologic mesh versus suture repair: a systematic review and meta-analysis

  • Systematic Review and Meta-analysis
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Laparoscopic repair of large hiatal hernias is associated with high recurrence rates. Erosion and mesh migration are rare but devastating complications of synthetic mesh repair, whereas reoperation is accompanied by significant operative morbidity. The aim of this study was to estimate the comparative risk of hernia recurrence following primary suture or biologic mesh repair.

Methods

A systematic literature search of the MEDLINE database was performed and comparative data of relevant studies were combined using the Mantel-Haenszel meta-analysis model. The odds ratio (OR) for hernia recurrence with 95 % confidence interval (CI) was calculated.

Results

Five relevant studies (two randomized controlled trials and three case-control studies) and one follow-up report of a randomized trial, encompassing 295 patients, were identified. Small intestine submucosa and human acellular cadaveric dermis were used as mesh grafts. Short-term recurrence rates were 16.6 and 3.5 % for suture repair and biologic mesh repair, respectively (OR 3.74, 95 % CI 1.55–8.98, p = 0.003). Long-term recurrence based on data provided by one trial only was 51.3 and 42.4 %, respectively (OR 1.43, 95 % CI 0.56–3.63, p = 0.45). Sensitivity analysis of the two randomized trials at short-term follow up demonstrated no significant difference (OR 2.54, 95 % CI 0.92–7.02, p = 0.07).

Conclusions

Biologic mesh repair of large hiatal hernias may confer short-term benefits in terms of hernia recurrence; however, the limited available information does not allow us to make conclusions about the long-term efficacy of biologic mesh in this setting. Individual biologic mesh grafts require further clinical assessment.

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Conflicts of interest

The authors declare no conflicts of interest.

Source of funding

None

Author’s contributions

• Study conception and design: SAA, BPMS, GAA, GK, RRL, GAA, RP, FAG

• Acquisition of data: SAA, GAA, GK

• Analysis and interpretation of data: SAA, BPMS, GAA, RP

• Drafting of manuscript: SAA, GAA, BPMS

• Critical revision of manuscript: BPMS, GAA, GK, RRL, GAA, RP, FAG

Author information

Authors and Affiliations

  1. Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany

    Stavros A. Antoniou & Frank-Alexander Granderath

  2. Department of General Surgery, University Hospital of Heraklion, Crete, Greece

    Stavros A. Antoniou

  3. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Beat P. Müller-Stich

  4. Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK

    George A. Antoniou

  5. Department of General Surgery, Sisters of Charity Hospital, Linz, Austria

    Gernot Köhler, Ruzica-Rosalia Luketina & Oliver O. Koch

  6. Department of General Surgery, Hospital Zell am See, Zell am See, Austria

    Rudolph Pointner

  7. Athinon-Souniou 11, 19001, Keratea Attikis, Athens, Greece

    Stavros A. Antoniou

Authors
  1. Stavros A. Antoniou
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  2. Beat P. Müller-Stich
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  3. George A. Antoniou
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  4. Gernot Köhler
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  5. Ruzica-Rosalia Luketina
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  6. Oliver O. Koch
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  7. Rudolph Pointner
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Corresponding author

Correspondence to Stavros A. Antoniou.

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Antoniou, S.A., Müller-Stich, B.P., Antoniou, G.A. et al. Laparoscopic augmentation of the diaphragmatic hiatus with biologic mesh versus suture repair: a systematic review and meta-analysis. Langenbecks Arch Surg 400, 577–583 (2015). https://doi.org/10.1007/s00423-015-1312-0

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  • DOI: https://doi.org/10.1007/s00423-015-1312-0

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