A clinical controlled study of mesh and non-mesh technique in laparoscopic repair of large hiatal hernias

Abstract

Objective To investigate the safety and effectiveness of mesh and non-mesh techniques in laparoscopic repair of large hiatal hernias (LRLHH). Methods A retrospective clinical controlled study of mesh and non-mesh techniques in LRLHH form January 2006 to August 2014 was performed. Results A total of 83 and 36 patients were recruited to mesh and non-mesh group respectively. There were no significant differences in operation time, operation bleeding volume, hospitalization time or complications between the two groups. Main symptoms were significantly improved during the postoperative long-term follow-up in both groups. The improvement of dysphagia in mesh group showed no significant difference [22.9%(19/83)VS 12.0%(10/83), P=0.066], however, non-mesh group showed significant difference [30.6%(11/36)VS 5.6%(2/36), P=0.006]. Rate of dysphagia alleviation in non-mesh group was significantly higher than that in mesh group[25.0%(9/36)VS 10.8%(9/83), P=0.048]. Mesh-related complications of esophageal erosions occurred in 5 patients (6.0%) in mesh group, including esophageal stenosis in 3 patients, esophageal-cardiac stricture in 1 patient. Recurrent hernia occurred in 1 patient (1.2%) in mesh group and 3 patients (8.3%) in non-mesh group (P=0.082). Conclusion LRLHH with mesh should be individualized. The use of mesh in LRLHH reduces the recurrence rate, but may lead to some complications. Key words: Hernia, hiatal; Laparoscopic repair; Mesh