Pre-existing hiatal mesh increases morbidity during and after revisional antireflux surgery: A retrospective multicenter study

David S Liu,King Tung Cheung,Sharon Lee,Jonathan Mccafferty,Hein Maung,Sean Stevens,Jasprit Singh,Lynn Chong,Manoj Anandan,Jonathan J Fong ,Darren Wong ,Tim Bright,Tunku Kamarul ,Sanjeeva Kariyawasam,James May,Hamza Ashraf,Felicia Ching Siew Ho,James M Gray ,Jack Menzie,Sara Mohammed Jinnaah,Geraldine Ooi,Emma Choong,Walter Santucci,Ahmad Aly,Emily Doole,Caitlin Marie Reid ,Brett Larner,Gabriel Lirios,Jie Qiao ,Gamze Aksakal,Luke Fairweather,Tiffany J Cherry ,Brianne Lauritz,Shipra Sankpal,Deanna Lee,Amy Crowe,Justin Yeung,Zexi Allan,Daniel Cox,Francesca Sasanelli,Su Kah Goh,Shantanu Joglekar,Amy Leathersich,Ra Nasser,Sally Wilkinson,Vivek Jayapadman,John Ibrahim ,Anh N Vu,Jed Hughes,Marwan Idrees,Emily Fitt,Hugh Elbourne,Sonia Gill,Adam Cichowitz,Sean Lim,Jessica Paynter,Vigneshkumar Palanisamy,Ashray Rajagopalan,Wael Jamel,Jordan Lee,George Kalogeropoulos,Krinal Mori,Colin Chan-Min Choi ,Shaoping Su ,Wei Qian ,Enoch Wong,Matthew Read,Zoe Zhang,Lobna Alukaidey,Kyle Bennett,Tianyuan Lu ,Vijayaragavan Muralidharan,Chon Hann Liew,Paul Cashin,Nevin Chen,Amie Hilder,Emma Downie,David I Watson,Roshini Nadaraja,Samantha Wong,Jonathon Holt

doi:10.1016/j.surg.2023.05.029

Abstract

BackgroundRevisional antireflux surgery, including hiatus hernia repair, is increasingly common. Mesh-augmented hiatal closure at the time of index operation is controversial but commonly performed. Although a meta-analysis of randomized data has demonstrated no additional benefit of routine mesh placement, it is unclear whether this practice results in harm, particularly at the time of revisional antireflux surgery. We determined whether pre-existing mesh at the hiatus increases morbidity during and after revisional antireflux surgery. MethodsAnalysis of prospectively-maintained databases of all elective revisional antireflux surgery cases in 36 hospitals across Australia took place over 10 years. Intraoperative and postoperative outcomes of patients with and without prior hiatal mesh were compared. Propensity score-matched analysis was used to validate primary findings. ResultsA total of 346 revisional cases (35 with pre-existing mesh) were analyzed. The 2 groups had comparable baseline characteristics. In total, 77 (22.2%) patients had 148 intraoperative adverse events. Pre-existing mesh was associated with a higher risk of intraoperative complications (48.6% vs 22.5%, odds ratio 3.25, 95% confidence interval 1.63–6.38, P = .002), secondary to bleeding, and lacerations to pleura, lung, and liver. Overall, 63 (18.2%) patients developed postoperative complications. Pre-existing mesh was associated with increased postoperative morbidity (37.1% vs 16.1%, odds ratio 3.09, 95% confidence interval 1.50–6.43, P = .005), particularly due to bleeding and respiratory complications. Importantly, pre-existing mesh independently predicted the occurrence of intraoperative and postoperative complications. ConclusionPrior hiatal mesh significantly increases morbidity during and after revisional antireflux surgery. Given that revisional surgery is increasingly being performed, our findings discourage routine mesh use during primary antireflux surgery.

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