Redo Nissen Fundoplication with and without Mesh to Re-Inforce Crural Repair: A Cohort Comparative Study

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Abstract Background The incidence of hiatal hernias increases with age. Approximately 55%-60% of individuals over the age of 50 have a hiatal hernia. However, only about 9% have symptoms, and it depends on the type and competency of the lower esophageal sphincter. The vast majority of these hernias are type I sliding hiatal hernias. Type II, paraesophageal hernias, only make up about 5% of hiatal hernias where the LES remains stationary, but the stomach protrudes above the diaphragm. There is also an increased prevalence in women, which could be attributed to increased intraabdominal pressure during pregnancy. Hiatal hernias are most common in Western Europe and North America and are rare in rural Africa. Aim of the Work This prospective – retrospective study aims to compare the efficacy of redo laparoscopic Nissen fundoplication with and without mesh repair for treatment of recurrent hiatus hernia after failed primary repair, regarding improvement of recurrent GERD symptoms, sliding hernia recurrence, and postoperative patients’ satisfaction. Patients and Methods In our study, prospective - retrospective randomized study was conducted on 30 patients who underwent redo laparoscopic Nissen fundoplication for the treatment of recurrent hiatus hernia with at least 1-year follow-up. A total of 15 patients underwent redo laparoscopic Nissen fundoplication, whereas 15 patients underwent the same technique with mesh reinforcement. Results Significant differences in postoperative reflux-associated symptoms were observed in both groups than preoperatively, but with a significant higher score for dysphagia noticed in the group in which mesh has been used. Anatomical recurrence occurred in four (26%) patients in the group of repair with out mesh after 12 months with relatively higher regurgitation, heartburn scores. Overall, patient's satisfaction was higher in the mesh group Conclusion Mesh reinforcement is associated with less recurrence rate in comparison with redo laparoscopic Nissen fundoplication alone during the short-term follow-up, but it is associated with more incidence of postoperative dysphagia. Mesh reinforcement is specially recommended for large defects more than 6 cm.