Castelijns P S S, Ponten J E H, van de Poll M C G, Nienhuijs S W, Smulders J F
Department of Surgery, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands.
Department of Surgery and Intensive Care Medicine, MUMC+, 6229 HX Maastricht, The Netherlands.
J Minim Access Surg. 2018 Apr-Jun;14(2):87-94. doi: 10.4103/jmas.JMAS_91_17.
Laparoscopic cruroplasty and fundoplication have become the gold standard in the treatment of hiatal hernia and gastro-oesophageal reflux disease (GERD). The use of a mesh-reinforcement of the cruroplasty has been proven effective; although, there is a lack of evidence considering which type of mesh is superior. The aim of this study was to compare recurrence rates after mesh reinforced cruroplasty using biological versus synthetic meshes.
We performed a systematic review of all clinical trials published between January 2004 and September 2015 describing the application of a mesh in the hiatal hernia repair during Nissen fundoplication for both GERD and hiatal hernia. The primary outcome was the recurrence rate, and secondary outcomes were complication rate, mortality and symptomatic outcome.
We included 16 studies and extracted data regarding 1089 mesh operated patients of whom 385 received a biological mesh and 704 a synthetic mesh. The mean follow-up was 53.4 months. The recurrence rate in the synthetic mesh group was 6.8% compared to 16.1% in the biological mesh group (P < 0.05). The complication rate was 5.1% and 4.6% (P = 0.694), respectively, and there were 12 mesh-related complications. No mesh-related mortality was reported.
Mesh reinforcement of hiatal hernia repair seems safe in the short-term follow-up. The available literature suggests no clear advantage of biological over synthetic meshes. Regarding cost-efficiency and short-term results, the use of synthetic nonabsorbable meshes might be advocated.
腹腔镜食管裂孔修补术和胃底折叠术已成为治疗食管裂孔疝和胃食管反流病（GERD）的金标准。已证实使用补片加强食管裂孔修补术是有效的；然而，缺乏证据表明哪种类型的补片更具优势。本研究的目的是比较使用生物补片与合成补片进行补片加强食管裂孔修补术后的复发率。
我们对2004年1月至2015年9月期间发表的所有临床试验进行了系统评价，这些试验描述了在针对GERD和食管裂孔疝的nissen胃底折叠术期间补片在食管裂孔疝修补中的应用。主要结局是复发率，次要结局是并发症发生率、死亡率和症状结局。
我们纳入了16项研究，并提取了1089例接受补片手术患者的数据，其中385例接受了生物补片，704例接受了合成补片。平均随访时间为53.4个月。合成补片组的复发率为6.8%，而生物补片组为16.1%（P<0.05）。并发症发生率分别为5.1%和4.6%（P = 0.694），有12例与补片相关的并发症。未报告与补片相关的死亡病例。
在短期随访中，食管裂孔疝修补术中使用补片加强似乎是安全的。现有文献表明生物补片并不比合成补片有明显优势。在成本效益和短期结果方面，可能提倡使用合成不可吸收补片。
