Laparoscopic Paraesophageal Hernia Repair: To Mesh or not to Mesh. Systematic Review and Meta-analysis
- PMID: 33843796
- DOI: 10.1097/SLA.0000000000004913
Laparoscopic Paraesophageal Hernia Repair: To Mesh or not to Mesh. Systematic Review and Meta-analysis
Abstract
Objective: This study aimed to compare outcomes after laparoscopic paraesophageal hernia repair (LPEHR) with mesh or primary repair alone.
Summary of background data: High recurrence rates after LPEHR have been reported. Whether the use of mesh improves outcomes remains elusive.
Methods: A systematic literature search was performed to identify randomized controlled trials (RCTs) comparing LPEHR with mesh repair versus suture repair alone. Early (≤6 months) and late (>6 months) recurrence rates were used as primary endpoints to assess efficacy. Intraoperative complications, overall morbidity, and reoperation rates were used as secondary endpoints to assess safety. A meta-analysis was conducted using relative risks (RR) with 95% confidence intervals (CI) for the analyzed outcomes.
Results: Seven RCTs comparing mesh (n = 383) versus suture only (n = 352) repair were included for analysis. Patients undergoing LPEHR with mesh reinforcement had similar early (RR = 0.74, 95% CI = 0.26-2.07, P = 0.46) and late (RR = 0.75, 95% CI = 0.27-2.08, P = 0.48) recurrence rates as those with primary repair. Similar recurrence rates were also found when stratifying the analysis by the type of mesh utilized (absorbable and nonabsorbable). Intraoperative complications (RR = 1.03, 95% CI = 0.33-3.28, P = 0.92) and reoperation rates (RR = 0.75, 95% CI = 0.29-1.92, P = 0.45) were also similar in both groups. Overall morbidity, however, was higher after mesh repair with nonabsorbable mesh (RR = 1.45, 95% CI = 1.24-1.71, P < 0.01).
Conclusions: Patients undergoing LPEHR have similar early and late recurrence rates with either mesh reinforcement or suture only repair, regardless of the type of mesh utilized. Overall morbidity, however, seems to be higher in patients repaired with nonabsorbable mesh.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Conflict of interest statement
The authors report no conflict of interest.
Comment in
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Comments on "Laparoscopic Paraesophageal Hernia Repair: To Mesh or Not to Mesh".Ann Surg. 2021 Dec 1;274(6):e942-e943. doi: 10.1097/SLA.0000000000004940. Ann Surg. 2021. PMID: 34016812 No abstract available.
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Comment on "Laparoscopic Paraesophageal Hernia Repair: to Mesh or Not to Mesh".Ann Surg Open. 2023 Jun 28;4(3):e304. doi: 10.1097/AS9.0000000000000304. eCollection 2023 Sep. Ann Surg Open. 2023. PMID: 37746622 Free PMC article. No abstract available.
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