Routine use of mesh during hiatal closure is safe with no increase in adverse sequelae

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Surgical Innovation

Background:

• Primary laparoscopic hiatal repair with fundoplication often results in high recurrence rates.
• The safety and efficacy of routine onlay-mesh use during hiatal closure require evaluation compared to primary repair alone.

Purpose of the Study:

• To assess the potential risks associated with routine onlay-mesh use in laparoscopic hiatal repair.
• To compare perioperative and long-term outcomes of mesh-reinforced hiatal closure versus primary repair.

Main Methods:

• A retrospective review of 505 patients undergoing primary laparoscopic hiatal repair with fundoplication from 2005-2014.
• Patients were divided into two groups: those receiving mesh reinforcement and those with primary repair alone.
• Perioperative outcomes were assessed via chart review, and long-term results were evaluated through patient questionnaires.

Main Results:

• No significant differences in 30-day perioperative outcomes were observed between the mesh and no-mesh groups.
• Long-term follow-up (median 4.29 years) showed no significant differences in dysphagia, heartburn, antacid use, or patient satisfaction.
• Symptomatic recurrence rates were 16.9% in the mesh group versus 22.4% in the no-mesh group (p=0.362), with no significant difference in reoperation rates.

Conclusions:

• Onlay-mesh use in laparoscopic hiatal repair with fundoplication is a safe procedure.
• Mesh reinforcement demonstrates similar short-term and long-term outcomes compared to primary repair alone.
• The routine use of onlay-mesh does not appear to increase risks or negatively impact patient outcomes.