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Mesh vs. non-mesh repair of type I hiatal hernias: a propensity-score matching analysis of 6533 patients from the Herniamed registry.
Hoffmann, H; Glauser, P; Adolf, D; Kirchhoff, P; Köckerling, F.
Affiliation
  • Hoffmann H; ZweiChirurgen GmbH, Center for Hernia Surgery and Proctology, Basel, Switzerland. hoffmann@zweichirurgen.ch.
  • Glauser P; Merian Iselin, Clinic for Orthopedics and Surgery, Basel, Switzerland. hoffmann@zweichirurgen.ch.
  • Adolf D; Solothurn Hospitals, Clinic for Surgery, Dornach, Switzerland.
  • Kirchhoff P; StatConsult GmbH, Magdeburg, Germany.
  • Köckerling F; ZweiChirurgen GmbH, Center for Hernia Surgery and Proctology, Basel, Switzerland.
Hernia ; 2024 Mar 29.
Article in En | MEDLINE | ID: mdl-38551794
ABSTRACT

INTRODUCTION:

Surgical treatment of type I hiatal sliding hernias aims to control the gastroesophageal reflux symptoms and prevention of hernia recurrence. Usually, a cruroplasty is performed to narrow the hiatal orifice. Here, it remains controversial if a mesh reinforcement of the cruroplasty should be performed, since benefits as well as mesh-associated complications have been described.

METHODS:

We performed a propensity-score matching analysis with data derived from the Herniamed registry comparing patients undergoing laparoscopic type I hiatal hernia repair with and without synthetic mesh. We analyzed perioperative, intraoperative, and postoperative data including data derived from the 1-year follow-up in the registry.

RESULTS:

6.533 patients with an axial, type I hiatal hernia and gastroesophageal reflux are included in this analysis. Mesh augmentation of the hiatoplasty was performed in n = 1.252/6.533 (19.2%) of patients. The defect size in the subgroup of patients with mesh augmentation was with mean 16.3 cm2 [14.5; 18.2] significantly larger as in the subgroups without mesh augmentation with 10.8 cm2 [8.7; 12.9]; (p < 0.001). In patients with mesh hiatoplasty n = 479 (38.3%) Nissen and n = 773 (61.7%) Toupet fundoplications are performed. 1.207 matched pairs could be analyzed. The mean defect size after matching was with 15.9 cm2 comparable in both groups. A significant association was seen regarding recurrence (4.72% mesh vs. 7.29% non-mesh hiatoplasty, p = 0.012). The same relation can be seen for pain on exertion (8.78% vs 12.10%; p = 0.014) and pain requiring treatment (6.13% vs 9.11%; p = 0.010). All other outcome parameter showed no significant correlation.

CONCLUSIONS:

Our data demonstrate that mesh-reinforced laparoscopic type I hiatal hernia repair in larger defects is associated with significantly lower rates for recurrence, pain on exertion and pain requiring treatment.
Key words

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Hernia Journal subject: GASTROENTEROLOGIA Year: 2024 Document type: Article Affiliation country: Suiza

Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Hernia Journal subject: GASTROENTEROLOGIA Year: 2024 Document type: Article Affiliation country: Suiza