Skip to main content

Advertisement

Log in

Laparoscopic repair of hiatus hernia: Does mesh type influence outcome? A meta-analysis and European survey study

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Synthetic mesh (SM) has been used in the laparoscopic repair of hiatus hernia but remains controversial due to reports of complications, most notably esophageal erosion. Biological mesh (BM) has been proposed as an alternative to mitigate this risk. The aim of this study is to establish the incidence of complications, recurrence and revision surgery in patients following suture (SR), SM or BM repair and undertake a survey of surgeons to establish a perspective of current practice.

Methods

An electronic search of EMBASE, MEDLINE and Cochrane database was performed. Pooled odds ratios (PORs) were calculated for discrete variables. To survey current practice an online questionnaire was sent to emails registered to the European Association for Endoscopic Surgery.

Results

Nine studies were included, comprising 676 patients (310 with SR, 214 with SM and 152 with BM). There was no significant difference in the incidence of complications with mesh compared to SR (P = 0.993). Mesh significantly reduced overall recurrence rates compared to SR [14.5 vs. 24.5 %; POR = 0.36 (95 % CI 0.17–0.77); P = 0.009]. Overall recurrence rates were reduced in the SM compared to BM groups (12.6 vs. 17.1 %), and similarly compared to the SR group, the POR for recurrence was lower in the SM group than the BM group [0.30 (95 % CI 0.12–0.73); P = 0.008 vs. 0.69 (95 % CI 0.26–1.83); P = 0.457]. Regarding surgical technique 503 survey responses were included. Mesh reinforcement of the crura was undertaken by 67 % of surgeons in all or selected cases with 67 % of these preferring synthetic mesh to absorbable mesh. One-fifth of the respondents had encountered mesh erosion in their career.

Conclusions

Both SM and BM reduce rates of recurrence compared to SR, with SM proving most effective. Surgical practice is varied, and there remains insufficient evidence regarding the optimum technique for the repair of hiatal hernia.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Dallemagne B, Kohnen L, Perretta S, Weerts J, Markiewicz S, Jehaes C (2011) Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg 253:291–296. doi:10.1097/SLA.0b013e3181ff44c0

    Article  PubMed  Google Scholar 

  2. Frantzides CT, Madan AK, Carlson MA, 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 

  3. Frantzides CT, Carlson MA, Loizides S, Papafili A, Luu M, Roberts J, Zeni T, Frantzides A (2010) Hiatal hernia repair with mesh: a survey of SAGES members. Surg Endosc 24:1017–1024. doi:10.1007/s00464-009-0718-6

    Article  PubMed  Google Scholar 

  4. Fuchs KH, Babic B, Breithaupt W, Dallemagne B, Fingerhut A, Furnee E, Granderath F, Horvath P, Kardos P, Pointner R, Savarino E, Van Herwaarden-Lindeboom M, Zaninotto G (2014) EAES recommendations for the management of gastroesophageal reflux disease. Surg Endosc 28:1753–1773. doi:10.1007/s00464-014-3431-z

    Article  PubMed  Google Scholar 

  5. Guidelines for the Management of Hiatal Hernia—A SAGES Guideline. http://www.sages.org/publications/guidelines/guidelines-for-the-management-of-hiatal-hernia/. Accessed 2 Jan 2015

  6. Furnée E, Hazebroek E (2013) Mesh in laparoscopic large hiatal hernia repair: a systematic review of the literature. Surg Endosc 27:3998–4008. doi:10.1007/s00464-013-3036-y

    Article  PubMed  Google Scholar 

  7. Antoniou SA, Antoniou GA, Koch OO, Pointner R, Granderath FA (2012) Lower recurrence rates after mesh-reinforced versus simple hiatal hernia repair: a meta-analysis of randomized trials. Surg Laparosc Endosc Percutan Tech 22:498–502. doi:10.1097/SLE.0b013e3182747ac2

    Article  PubMed  Google Scholar 

  8. Memon MA, Memon B, Yunus RM, Khan S (2015) Suture cruroplasty versus prosthetic hiatal herniorrhaphy for large hiatal hernia. Ann Surg. doi:10.1097/SLA.0000000000001267

    Google Scholar 

  9. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188. doi:10.1016/0197-2456(86)90046-2

    Article  CAS  PubMed  Google Scholar 

  10. Higgins JPT, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558. doi:10.1002/sim.1186

    Article  PubMed  Google Scholar 

  11. Stadlhuber RJ, El Sherif A, Mittal SK, Fitzgibbons RJ, Michael Brunt L, Hunter JG, Demeester TR, Swanstrom LL, Daniel Smith C, Filipi CJ (2009) Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 23:1219–1226. doi:10.1007/s00464-008-0205-5

    Article  PubMed  Google Scholar 

  12. Rumstadt B, Kähler G, Mickisch O, Schilling D (2008) Gastric mesh erosion after hiatoplasty for recurrent paraesophageal hernia. Endoscopy 40(Suppl 2):E70. doi:10.1055/s-2007-995332

    Article  PubMed  Google Scholar 

  13. 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. doi:10.1097/SLE.0b013e3181a11926

    Article  PubMed  Google Scholar 

  14. Chilintseva N, Brigand C, Meyer C, Rohr S (2012) Laparoscopic prosthetic hiatal reinforcement for large hiatal hernia repair. J Visc Surg 149:e215–e220. doi:10.1016/j.jviscsurg.2012.01.006

    Article  CAS  PubMed  Google Scholar 

  15. Müller-Stich BP, Holzinger F, Kapp T, Klaiber C (2006) Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement. Surg Endosc 20:380–384. doi:10.1007/s00464-004-2272-6

    Article  PubMed  Google Scholar 

  16. 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. doi:10.1097/01.sla.0000237759.42831.03

    PubMed  PubMed Central  Google Scholar 

  17. 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. doi:10.1016/j.jamcollsurg.2011.05.017

    Article  PubMed  Google Scholar 

  18. Leeder PC, Smith G, Dehn TCB (2003) Laparoscopic management of large paraesophageal hiatal hernia. Surg Endosc 17:1372–1375. doi:10.1007/s00464-002-9192-0

    Article  CAS  PubMed  Google Scholar 

  19. Watson DI, Thompson SK, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG (2014) Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial. Ann Surg. doi:10.1097/SLA.0000000000000842

    PubMed Central  Google Scholar 

  20. Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140:40–48. doi:10.1001/archsurg.140.1.40

    Article  PubMed  Google Scholar 

  21. Zaninotto G, Portale G, Costantini M, Fiamingo P, Rampado S, Guirroli E, Nicoletti L, Ancona E (2007) Objective follow-up after laparoscopic repair of large type III hiatal hernia. Assessment of safety and durability. World J Surg 31:2177–2183. doi:10.1007/s00268-007-9212-2

    Article  PubMed  Google Scholar 

  22. Morino M, Giaccone C, Pellegrino L, Rebecchi F (2006) Laparoscopic management of giant hiatal hernia: factors influencing long-term outcome. Surg Endosc 20:1011–1016. doi:10.1007/s00464-005-0550-6

    Article  CAS  PubMed  Google Scholar 

  23. Ringley CD, Bochkarev V, Ahmed SI, Vitamvas ML, Oleynikov D (2006) Laparoscopic hiatal hernia repair with human acellular dermal matrix patch: our initial experience. Am J Surg 192:767–772. doi:10.1016/j.amjsurg.2006.08.042

    Article  PubMed  Google Scholar 

  24. Schmidt E, Shaligram A, Reynoso JF, Kothari V, Oleynikov D (2014) Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias. Dis Esophagus 27:13–17. doi:10.1111/dote.12042

    Article  CAS  PubMed  Google Scholar 

  25. Granderath FA, Granderath UM, Pointner R (2008) Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg 32:999–1007. doi:10.1007/s00268-008-9558-0

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George B. Hanna.

Ethics declarations

Disclosures

Jeremy R. Huddy, Sheraz R. Markar, Melody Z. Ni, Mario Morino, Edoardo M. Targarona, Giovanni Zaninotto and George B. Hanna have no conflict of interest.

Appendix 1: European Association of Endoscopic Surgeons Questionnaire

Appendix 1: European Association of Endoscopic Surgeons Questionnaire

figure afigure a

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huddy, J.R., Markar, S.R., Ni, M.Z. et al. Laparoscopic repair of hiatus hernia: Does mesh type influence outcome? A meta-analysis and European survey study. Surg Endosc 30, 5209–5221 (2016). https://doi.org/10.1007/s00464-016-4900-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-016-4900-3

Keywords

Navigation