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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
Statement of
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.
RMID: 1000016426
DOI: 10.1097/sla.0000000000003734
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Appears in Collections:Medicine publications

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