Shubham Gupta, MS, Gagandeep Talwar, Jasmine Agarwal, Amol Wagh, MS, Saurabh Gandhi, MS, Eham Arora, MS. Grant Government Medical College & Sir J.J. Group of Hospitals, Mumbai, India
OBJECTIVE: The study was performed to assess whether sutured crural closure or mesh reinforcement for hiatal closure yields better results with regards to symptom resolution and recurrence post-operatively.
MATERIAL AND METHODS: A prospective randomized controlled trial was carried out at Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India. Patients were randomized to receive either sutured repair or mesh reinforcement of hiatal closure. Outcomes of interest were symptom resolution, quality of life scores and recurrence in the post-operative period.
RESULTS: 160 patients were recruited for the trial (80-sutured repair, 80-mesh reinforcement). The two groups were comparable in terms of demographic profiles, symptom severity and findings at esophagogastroscopy and manometry in the pre-operative period as well as size of the hiatal defect measured intra-operatively. Post-operatively the mesh repair group had significantly better symptom resolution in terms of early satiety, chest pain and regurgitation (p<0.05) while with respect to heartburn, dysphagia and post-prandial pain there was no significant difference between the improvements demonstrated. Improvement in Quality of life scores after either procedure was not significantly different. Recurrence was higher in the suture repair group (8 vs 0, p<0.001). Recurrence lead to poorer symptom severity scores as well as quality of life scores and one patient underwent re-operation.
The change in the symptom severity score from baseline after the procedure at 6 months in the subgroup population.
CONCLUSION: Mesh reinforcement results in a reduced rate of recurrence and offers excellent symptom control in the short-term without a rise in complications when compared to sutured repair for the closure of hiatal defects in laparoscopic hiatal hernia repairs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87287
Program Number: P390
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster