Five Year Follow-up of a Randomized Controlled Trial of Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Versus Nonabsorbable Mesh

Ann Surg. 2020 Aug;272(2):241-247. doi: 10.1097/SLA.0000000000003734.

Abstract

Objective: To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair.

Summary of background data: Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair.

Methods: Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years.

Results: 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh.

Conclusions: No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Absorbable Implants
  • Adult
  • Analysis of Variance
  • Australia
  • Chi-Square Distribution
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Hernia, Hiatal / diagnostic imaging
  • Hernia, Hiatal / surgery*
  • Herniorrhaphy / adverse effects
  • Herniorrhaphy / methods*
  • Humans
  • Laparoscopy / adverse effects
  • Laparoscopy / methods*
  • Male
  • Middle Aged
  • Prospective Studies
  • Recurrence
  • Reoperation / methods
  • Risk Assessment
  • Severity of Illness Index
  • Surgical Mesh / adverse effects*
  • Suture Techniques*
  • Time Factors
  • Treatment Outcome
  • Wound Healing / physiology

Associated data

  • ANZCTR/ACTRN12605000725662