Laparoscopic Antireflux Surgery: A Comparative Study of Nissen Fundoplication and Hiatoplasty With and Without Absorbable Biological Mesh

Abstract

Background: Laparoscopic Nissen fundoplication with hiatoplasty has been shown to be an effective antireflux operation. The use of biological mesh in hiatoplasty has been controversial. Method: This retrospective comparative study included all patients with severe symptomatic gastro-oesophageal reflux disease who underwent antireflux surgery with and without biological mesh repair in one surgeons practice, 202 patients who underwent Nissen fundoplication with hiatus hernia repair between 2000 and 2010 were retrospectively analysed. Patients were divided into 4 groups: large paraoesophageal hernia with Surgisis mesh (n = 24) and without (n = 61); and patients without hiatal hernia with Surgisis mesh (n = 26) and without (n = 91). The Incidence of recurrence of hiatal hernia and post-operative side-effects were the outcome measures. Results: In the group with paraoesophageal hernia at approximately 6 months postoperatively, the side-effects reported by patients without Surgisis mesh were reflux (15%), flatulence (28%), dysphagia (46%), and hiatal hernia recurrence (13%). Comparatively, patients receiving Surgisis mesh repair reported side effects of reflux (8%), flatulence (17%), dysphagia (75%), and hiatal hernia recurrence (4%). In the group without large hernia, the side-effects reported by patients without Surgisis mesh were reflux (12%), flatulence (20%), dysphagia (41%), and incidence of hiatal hernia (1%) and in patients with Surgisis mesh repair the rates of side-effects were: reflux (11%), flatulence (19%), dysphagia (69%), and incidence of hiatal hernia (3.8%). Conclusion: This retrospective analysis shows that antireflux surgery with an absorbable biological mesh hiatoplasty is safe, and may lead to a reduction in the incidence of recurrent hiatal hernia. It also produces good control of reflux, with low risk of side-effects and complications. doi: http://dx.doi.org/10.4021/jcs185w