Hiatal hernia repair: A single-institution experience and risk factors associated with early symptomatic recurrence

Symptomatic recurrence after hiatal hernia repair poses several challenges, particularly as surgical options are limited. The use of mesh during hiatal hernia repair is controversial, as it is associated with long-term complications and a higher morbidity rate in case of redo surgery. Nevertheless, proponents of this technique argue that its use might reduce the risk of recurrence.

A retrospective analysis of hiatal hernia repair from 2011 to 2022 performed at our clinic was conducted. All hiatus defects were closed using barbed nonresorbable sutures without mesh. Univariate and multivariate logistic regression analyzed patient and operative characteristics for associations with early symptomatic recurrence in patients with ≥12-month follow-up. Early symptomatic recurrence was defined as redo surgery within 1-year post-primary repair. Kaplan-Meier estimator and log-rank test assessed cumulative recurrence rate.

Of 1,226 patients with hiatal hernia repair, 74.1% (n = 908) were female, median age was 65 years (interquartile range 54, 72), and median body mass index was 28 kg/m² (interquartile range 25, 33). Of repairs, 99.6% (n = 1,221) were laparoscopic and 14.4% (n = 177) were redo surgery, of which 43 had a previous mesh placement. Reoperation and mortality rates at 30 days were 2.6% (n = 32) and 0.1% (n = 1), respectively. Median follow-up was 12 months (interquartile range 1, 44). Symptomatic recurrences requiring reoperation were observed in 47 (3.8%) cases. In the univariate and multivariate logistic regression of 610 patients with ≥12-month follow-up, 2.5% (n = 15) experienced symptomatic recurrences. Open repair (odds ratio 5.37, P = .008) and redo surgery with previous mesh (odds ratio 7.69, P = .013) were independent risk factors for early recurrence with an area under the curve of 0.64. The cumulative recurrence rate at 1 year was significantly impacted by mesh use in previous repair (7.3%) compared with no mesh (2.9%) or no previous repair (1.4%) (P = .024).

Barbed nonresorbable suture closure during hiatal hernia repair is safe and effective in the short term. Open repair and redo surgery with previous mesh placement were associated with higher 1-year recurrence rates, underscoring the need for careful consideration in surgical planning.