Panait Lucian, Novitsky Yuri W
AtlantiCare Physician Group Department of Surgery Egg Harbor Township, New Jersey.
Case Western Reserve School of Medicine, Cleveland Comprehensive Hernia Cente, Cleveland Comprehensive Hernia Center, Department of Surgery, University Hospitals Cleveland Medical Center Cleveland, Ohio.
Surg Technol Int. 2017 Jul 25;30:182-187.
There continues to be debate regarding the best surgical technique for the treatment of paraesophageal hernias. While laparoscopic and robotic approaches are widely employed around the world, the benefits of mesh use to reinforce hiatal closure are still not well established. The goal of this manuscript is to describe the currently available results with biologic and bioabsorbable meshes for treatment of paraesophageal hernias, particularly with reference to the rate of recurrence.
A systematic review of the literature was conducted to identify studies describing treatment of hiatal hernias with biologic or bioabsorbable mesh. The available studies were categorized as comparative (when authors compared results with a different patient cohort undergoing suture repair of the hiatus without mesh reinforcement) and non-comparative, and organized by levels of evidence.
We identified two randomized control trials, a long-term follow-up to one of the trials, a prospective case control study, one retrospective case control study, two meta-analyses of the above-mentioned studies, as well as 11 non-comparative studies, which included two prospective, 10 retrospective, and two case series. Most studies involved the use of different biologic meshes, while bioabsorbable mesh use was only described in four of the retrospective studies mentioned. The results are variable, however, most authors found a benefit from hiatal closure reinforcement with mesh.
The available literature lacks definitive evidence to support the use of biologic or bioabsorbable materials to reinforce hiatal closure in the cure of paraesophageal hernias. Further studies are needed to assess newer materials and longer-term effects of existing products.
关于治疗食管旁疝的最佳手术技术一直存在争议。虽然腹腔镜和机器人手术方法在世界各地广泛应用，但使用补片加强裂孔闭合的益处仍未得到充分证实。本文的目的是描述目前使用生物和生物可吸收补片治疗食管旁疝的结果，特别是关于复发率。
对文献进行系统回顾，以确定描述使用生物或生物可吸收补片治疗裂孔疝的研究。现有研究分为比较性研究（作者将结果与另一组未使用补片加强裂孔缝合修复的患者队列进行比较）和非比较性研究，并按证据水平进行组织。
我们确定了两项随机对照试验、其中一项试验的长期随访、一项前瞻性病例对照研究、一项回顾性病例对照研究、上述研究的两项荟萃分析，以及11项非比较性研究，其中包括两项前瞻性研究、10项回顾性研究和两项病例系列研究。大多数研究涉及使用不同的生物补片，而生物可吸收补片的使用仅在上述四项回顾性研究中有所描述。结果各不相同，然而，大多数作者发现使用补片加强裂孔闭合有好处。
现有文献缺乏确凿证据支持在治疗食管旁疝时使用生物或生物可吸收材料加强裂孔闭合。需要进一步研究来评估新材料和现有产品的长期效果。
