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|Title:||Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh|
|Citation:||Annals of Surgery, 2015; 261(2):282-289|
|Publisher:||Lippincott Williams & Wilkins|
|David I. Watson, Sarah K. Thompson, Peter G. Devitt, Lorelle Smith, Simon D. Woods, Ahmad Aly, Susan Gan, Philip A. Game and Glyn G. Jamieson|
|Abstract:||Objective: Determine whether absorbable or nonabsorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared with suture repair. Background: Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has been recommended. Previous trials have shown less short-term recurrence with mesh, but adverse outcomes limit mesh use. Methods: Multicentre prospective double blind randomized controlled trial of 3 methods of repair: sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome—hernia recurrence assessed by barium meal radiology and endoscopy at 6 months. Secondary outcomes—clinical symptom scores at 1, 3, 6, and 12 months. Results: A total of 126 patients enrolled: 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Among them, 96.0% were followed up to 12 months, with objective follow-up data in 92.9%. A recurrent hernia (any size) was identified in 23.1% after suture repair, 30.8% after absorbable mesh, and 12.8% after nonabsorbable mesh (P = 0.161). Clinical outcomes were similar, except less heartburn at 3 and 6 months and less bloating at 12 months with nonabsorbable mesh; more heartburn at 3 months, odynophagia at 1 month, nausea at 3 and 12 months, wheezing at 6 months; and inability to belch at 12 months after absorbable mesh. The magnitudes of the clinical differences were small. Conclusions: No significant differences were seen for recurrent hiatus hernia, and the clinical differences were unlikely to be clinically significant. Overall outcomes after sutured repair were similar to mesh repair.|
|Keywords:||Hiatus hernia; laparoscopy; mesh repair; randomized controlled trial|
|Rights:||Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.|
|Appears in Collections:||Medicine publications|
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