Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Mesh Versus Nonabsorbable Mesh: A Randomized Controlled Trial

• Published in: Annals of surgery Vol. 261; no. 2; pp. 282 - 289
• Main Authors: Watson, David I, Thompson, Sarah K, Devitt, Peter G, Smith, Lorelle, Woods, Simon D, Aly, Ahmad, Gan, Susan, Game, Philip A, Jamieson, Glyn G
• Format: Journal Article
• Language: English
• Published: United States by Lippincott Williams & Wilkins 01-02-2015
• Subjects: Aged; Double-Blind Method; Female; Follow-Up Studies; Hernia, Hiatal - prevention & control; Hernia, Hiatal - surgery; Herniorrhaphy - instrumentation; Herniorrhaphy - methods; Humans; Laparoscopy - instrumentation; Laparoscopy - methods; Male; Middle Aged; Prospective Studies; Recurrence; Surgical Mesh; Sutures; Treatment Outcome
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000000842

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 repairsutures 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 enrolled43 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.