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Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair.

Surgical Endoscopy 2018 August
BACKGROUND: Primary repair of large hiatal hernia is associated with a high recurrence rate. The use of mesh can lead to a reduce of recurrence rate. Despite this reduction, the type of mesh used and the placement technique are controversial. In our study, we used a new type of non-absorbable, self-fixating mesh to reinforce the cruroplasty. The aim of the present study was to compare the long-term results of laparoscopic treatment of large hiatal hernia with mesh reinforcement versus simple crura repair.

METHODS: This study was performed on 98 gastroesophageal reflux disease patients who underwent Nissen fundoplication with mesh-augmented crura repair and fundoplication with standard crura repair. We used non-absorbable laparoscopic self-fixating mesh by ProGrip™. All patients were separated into the mesh group (n = 50) and non-mesh group (n = 48). The groups were evaluated according to the following criteria: dysphagia, patients' symptomatic outcome judgment according to The Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) questionnaire and patients' satisfaction, hiatal hernia recurrence according to upper endoscopy and a barium contrast swallow study. Follow-up was completed in 95 (97%) patients with a mean follow-up duration of 54 months (range 12-62 months).

RESULTS: Mean operative time was not significantly different (p = 0.30302). During the 48 months of follow-up, one recurrence occurred in the mesh group and eight recurrences appeared in the non-mesh group (p = 0.027). Patient satisfaction was significantly higher in the mesh group (p = 0.004). The mesh group had a more significant improvement in GERD-HRQL score (p < 0.0001) compared to the non-mesh group.

CONCLUSION: In conclusion, this study confirms that laparoscopic repair of large hiatal hernias is effective and durable over a long period of time. Reinforcement of crura repair with ProGrip™ mesh is safe and can prevent anatomical recurrences.

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