Could Mesh Placement Solve the Problem of High Radiological and Symptomatic Recurrence in Patients with a Large Sliding Hiatal Hernia? A Prospective Comparative Study | ||
| Ain Shams Journal of Surgery | ||
| Volume 17, Issue 2, April 2024, Pages 160-168 PDF (959.08 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asjs.2024.351446 | ||
| Authors | ||
| Tarek Abouzeid Osman; Ahmed Ain Shoka; Ramy Helmy Fouad | ||
| Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||
| Abstract | ||
| Introduction: Large sliding Hiatal Hernia (HH) is associated with an exceedingly high incidence of recurrence after surgery. An ongoing controversy exists while managing it regarding the best surgical technique. We aimed to compare laparoscopic mesh hernioplasty to laparoscopic suture crurorraphy for a large HH in terms of the diseasespecific Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score, HH recurrence, and postoperative complications. Patients and methods: This prospective study was conducted between December 2019 to August 2023 on patients diagnosed with a large sliding HH and refractory GERD undergoing either laparoscopic suture crurorraphy (Group A) or laparoscopic mesh hernioplasty using the Symbotex™ composite mesh (Group B). Patients were assessed for GERD-HRQL score, postoperative complications, recurrence of symptoms, or hernia. Results: Throughout the study period, 34 patients with refractory GERD and large HH were included. Both techniques were comparable with no statistically significant difference in the operative time (78.7 ±18.9 min vs 81.1 ± 17.4, p=0.54), hospital stay (2.8 ± 0.6 days vs 2.6 ± 0.9, p=0.42), and postoperative complications (5 vs 6, p=1). Mesh placement was associated with a statistically significant lower rate of recurrence (P=0.042). GERD HRQL score was significantly lower in the mesh hernioplasty group at 6 months (p=0.042), 12 months (p=0.036) and 18 months (p=00.023). Conclusion: Mesh placement significantly reduced the recurrence of a large HH and was associated with more improvement in the GERD HRQL score. | ||
| Keywords | ||
| Gastroesophageal reflux disease; laparoscopic Toupet fundoplication; large hiatal hernia; suture crurorraphy; Symbotex mesh | ||
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