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World J Surg ; 48(6): 1448-1457, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38629870

RESUMEN

INTRODUCTION: The use of prosthetic mesh in laparoscopic repair of large hiatus hernias remains controversial. Clinical and quality of life outcomes from a randomized controlled trial of mesh versus suture repair previously showed few differences at early follow-up. This study evaluated longer-term quality of life outcomes from that trial. METHODS: A prospective, multicentre, double blind randomized controlled trial assessed three methods of repair for large hiatus hernias: sutures-only versus absorbable mesh versus non-absorbable mesh. Quality of life was assessed using the Short-Form 36 (SF-36) questionnaire which was completed preoperatively and then at 3, 6, 12 months following surgery and annually thereafter. SF-36 outcomes were compared across the three repair techniques at longer-term follow-up (3-6 years), and to earlier baseline and 12-month outcomes. RESULTS: 126 patients were randomized; 43-suture-only, 41-absorbable mesh and 42-non-absorbable mesh. Questionnaires were completed by 118 patients preoperatively, 115 at 12 months and 98 at longer-term follow-up (median 5 years). There were no significant differences between the repair techniques for the subscale and composite scores at longer-term follow-up. The mental component score improved significantly after surgery and was sustained across follow-up for all techniques. The physical component score also improved significantly but was lower at longer-term follow-up compared to the 12-month follow up in both mesh groups. CONCLUSION: Surgical repair of large hiatus hernias provides sustained long-term improvement in quality of life. The addition of mesh does not improve quality of life. TRIAL REGISTRATION: This trial is registered with the Australia and New Zealand Clinical Trials Registry ACTRN12605000725662.


Asunto(s)
Hernia Hiatal , Herniorrafia , Laparoscopía , Calidad de Vida , Mallas Quirúrgicas , Humanos , Hernia Hiatal/cirugía , Femenino , Masculino , Herniorrafia/métodos , Herniorrafia/instrumentación , Método Doble Ciego , Estudios Prospectivos , Estudios de Seguimiento , Persona de Mediana Edad , Anciano , Laparoscopía/métodos , Resultado del Tratamiento , Encuestas y Cuestionarios , Adulto
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