The use of mesh in Laparoscopic large hiatal hernia repair: A systematic review of the literature

Edgar Furnee, MD, PhD, Eric Hazebroek, MD, PhD

Diakonessenhuis, Utrecht, The Netherlands; St. Antonius Hospital, Nieuwegein, The Netherlands

Introduction:
The purpose of this study was to summarize the currently available literature on the use of mesh in laparoscopic large hiatal hernia (type II-IV) repair, in order to explore if mesh reduces the anatomical recurrence rate.

Methods:
A structured search of the literature was performed in the electronic database of Medline, Embase and Cochrane Central Register of Controlled trials. Studies on the anatomical outcome after laparoscopic large hiatal hernia repair with the use of mesh were identified by using explicit in- and exclusion criteria. Data were extracted from the included studies and analyzed using SPSS for Windows version 15.0.

Results:
A total of 30 studies met the inclusion criteria. There were three randomized controlled trials, seven prospective and five retrospective cohort studies and five prospective and one retrospective case-control (use of mesh vs. no mesh) studies. The study design was not reported in the remaining studies. In the included studies, laparoscopic hiatal hernia repair was performed with mesh in a total of 937 patients (mesh group) and without mesh in 351 patients (non-mesh group). The type of mesh used was very different; polypropylene in six, TiMesh in two, biomesh in five, Dual mesh in two and Alloderm in four studies. At least three different kinds of meshes were used in seven studies. The type of mesh was not reported in the other studies. The mean (± SD) area of the mesh was 51.9 ± 41.9cm2. The configuration of the mesh was like an A-, U-, Y- or V-shape, semicircular, oval or square. The mesh was positioned posterior to the esophagus in 18 studies, anterior in two, around the esophagus in one study and this was not reported in the remaining studies. The mesh was fixated with stitches, staplers and/ or glue. Radiological and/ or endoscopic follow-up was performed after a mean (± SD) period of 25.2 ± 16.6 months. There was no or only a small recurrence (recurrent hiatal hernia < 2cm) in 387 of the 451 available patients (85.5%) in the mesh group and 187 of the 246 (76.0%) in the non-mesh group. An esophageal erosions caused by the mesh was reported in one patient. Three patients had dysphagia due to extensive adhesion formation around the mesh.

Conclusions:
The use of mesh in the repair of large hiatal hernias is promising with regard to the reduction of anatomical recurrences. However, many different kinds of meshes are available. Therefore, high quality randomized controlled trials should be performed to obtain the most effective and safe mesh on the long term.

Session: Poster Presentation

Program Number: P237