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https://hdl.handle.net/2440/128249
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Type: | Journal article |
Title: | Five year follow-up of a randomized controlled trial of laparoscopic repair of very large hiatus hernia with sutures versus absorbable versus nonabsorbable mesh |
Author: | Watson, D.I. Thompson, S.K. Devitt, P.G. Aly, A. Irvine, T. Woods, S.D. Gan, S. Game, P.A. Jamieson, G.G. |
Citation: | Annals of Surgery, 2019; 272(2):241-247 |
Publisher: | Lippincott, Williams & Wilkins |
Issue Date: | 2019 |
ISSN: | 0003-4932 1528-1140 |
Statement of Responsibility: | David I. Watson, Sarah K. Thompson, Peter G. Devitt, Ahmad Aly, Tanya Irvine, Simon D. Woods ... et al. |
Abstract: | OBJECTIVE:To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair. SUMMARY OF BACKGROUND DATA:Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair. METHODS:Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years. RESULTS:126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh. CONCLUSIONS:No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias. |
Keywords: | Hiatus hernia; laparoscopy; mesh repair; randomized controlled trial |
Rights: | © 2019 Wolters Kluwer Health, Inc. All rights reserved. |
DOI: | 10.1097/sla.0000000000003734 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1022722 http://purl.org/au-research/grants/nhmrc/375111 |
Published version: | http://dx.doi.org/10.1097/sla.0000000000003734 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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