Department of Surgery, Isala Zwolle, Dr. Van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3430 VB, Nieuwegein, The Netherlands.
Surg Endosc. 2017 Sep;31(9):3673-3680. doi: 10.1007/s00464-016-5405-9. Epub 2017 Jan 11.
Laparoscopic hiatal hernia repair has become standard practice for most surgeons performing antireflux surgery. Hiatal hernia repair consists of cruroplasty with sutures only or additional reinforcement using mesh. Use of mesh was initiated to reduce recurrence rates. Recent analyses show that use of mesh may influence radiologic recurrence rates, but it does not seem to prevent symptomatic recurrences and the need for reoperation. This study compares clinical and radiologic outcomes of primary cruroplasty and cruroplasty with non-absorbable mesh after laparoscopic hiatal hernia repair.
Retrospective analysis of prospectively followed cohort of patients undergoing laparoscopic correction of hiatal hernia type II-IV in two tertiary referral centers was carried out. Radiologic recurrence, symptomatic recurrence, reoperation rate, complications and patient-reported outcome measures were analyzed for all patients.
A total of 189 patients were analyzed after laparoscopic hiatal hernia correction with an additional fundoplication [127 (67.2%) primary correction, 62 (32.8%) with mesh reinforcement]. After a mean follow-up of 39.3 months, the overall radiologic recurrence rate was 24.3%, which was equal in both groups [25.8% (mesh) vs 23.6% (no mesh), P = 0.331]. Symptomatic recurrence rate was 13.2% (16.1 vs 11.8%, P = 0.495) and reoperation rate 7.4% (9.7 vs 6.3%), which was comparable between the two groups. Complication rates were equal, and no serious mesh-related complications were reported. Health-related quality of life improved after surgery, dysphagia decreased and patient satisfaction was high for both groups without significant differences.
Radiologic recurrences, symptomatic recurrences and reoperation rates are equal after laparoscopic hiatal hernia repair with or without non-absorbable mesh reinforcement, irrespective of hernia size and type. Quality of life, dysphagia and patient satisfaction were comparable. No serious mesh-related complications occurred. The results of this study do not support the routine use of mesh in hiatal hernia repair.
腹腔镜食管裂孔疝修补术已成为大多数行抗反流手术的外科医生的标准手术方法。食管裂孔疝修补术包括仅缝线缝合的胃底折叠术或使用补片进行额外的加固。使用补片是为了降低复发率。最近的分析表明，使用补片可能会影响放射学复发率，但似乎并不能预防症状性复发和再次手术的需要。本研究比较了腹腔镜食管裂孔疝修补术后原发性胃底折叠术和非吸收性补片胃底折叠术的临床和放射学结果。
对在两个三级转诊中心行腹腔镜 II-IV 型食管裂孔疝矫正的前瞻性随访队列患者进行回顾性分析。对所有患者进行放射学复发、症状性复发、再次手术率、并发症和患者报告的结果测量分析。
腹腔镜食管裂孔疝修补术后共分析了 189 例患者，其中 127 例（67.2%）行原发性矫正，62 例（32.8%）行补片加固。平均随访 39.3 个月后，总体放射学复发率为 24.3%，两组间相等[补片组 25.8%（62 例），非补片组 23.6%（127 例），P=0.331]。症状性复发率为 13.2%（补片组 16.1%，非补片组 11.8%，P=0.495），再次手术率为 7.4%（补片组 9.7%，非补片组 6.3%），两组间无显著差异。并发症发生率相等，且均未报告严重的补片相关并发症。两组患者的健康相关生活质量均得到改善，吞咽困难减轻，患者满意度高，且无显著差异。
腹腔镜食管裂孔疝修补术后使用或不使用不可吸收补片加固，无论疝大小和类型如何，放射学复发、症状性复发和再次手术率均相等。生活质量、吞咽困难和患者满意度相当。未发生严重的补片相关并发症。本研究结果不支持食管裂孔疝修补术中常规使用补片。
