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Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis

  • 2022 SAGES Poster
  • Published:
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Abstract

Introduction

The use of bioabsorbable mesh at the hiatus is controversial. Long-term data are scant. We evaluated the world literature and performed a meta-analysis to determine if these meshes were effective in reducing recurrence.

Methods

A literature search was performed using PubMed, MEDLINE, and ClinicalKey. We evaluated articles reporting on both Bio-A™ (polyglycolic acid:trimethylene carbonate—PGA:TMC) and Phasix™ (poly-4-hydroxybutyrate—P4HB) used at the hiatus. The DerSimonian–Laird random effects model was used to estimate the overall pooled treatment effect along with a 95% confidence interval (CI). Similar analysis was conducted to compare the clinical outcomes, i.e., recurrence rate, mean surgical time, mean hospital stays and mean follow-up duration between non-Mesh and Mesh group. The I2 statistic was computed to assess the heterogeneity in effect sizes across the studies.

Results

A total of 21 studies (12 mesh studies with 963 subjects and 9 non-mesh studies with 617 subjects) were included to conduct the meta-analysis. There was one article reporting outcomes on P4HB mesh (73 subjects) and 11 on PGA:TMC mesh (890 subjects). The bioabsorbable mesh group had a significantly lower recurrence rate compared to the non-mesh group (8% vs. 18%; 95%CI 0.08−0.17), pooled p-value < 0.0001. Surgery time was shorter in the mesh group compared to the non-mesh group (136.4 min vs. 150 min) but not statistically significant (p = 0.54). There tended to be a more extended follow-up period after surgery in the non-mesh group compared to the mesh group (27 vs. 25.8 months, range 10.8–54 months); but not statistically significant (ES: 27.4; 95%CI 21.6−33.3; p = 0.92).

Conclusions

Hiatal hernia repair with bioabsorbable mesh is more effective at reducing hernia recurrence rate in the mid-term than simple suture cruroplasty. Further studies investigating the long-term outcomes and P4HB mesh are needed.

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Authors and Affiliations

  1. Department of Surgery, Texas Tech University Health Sciences Center El Paso, 1700 N. Mesa, El Paso, TX, 79902, USA

    Benjamin Clapp, Ali M. Kara, Paul J. Nguyen-Lee, Hani M. Annabi, Luis Alvarado, John D. Marr & Brian Davis

  2. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Omar M. Ghanem

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Benjamin Clapp, Ali M. Kara, John D. Marr, Paul J Nguyen-Lee, Hani M Annabi, Luis Alvarado; Omar M Ghanem and Brian Davis have no conflicts of interest or financial ties to disclose.

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Clapp, B., Kara, A.M., Nguyen-Lee, P.J. et al. Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis. Surg Endosc 37, 2295–2303 (2023). https://doi.org/10.1007/s00464-022-09514-1

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