title: Lower recurrence rates after mesh-reinforced versus simple hiatal hernia repair: a meta-analysis of randomized trials.
abstract: Mesh hiatoplasty has been postulated to reduce recurrence rates, it is however prone to esophageal stricture, and early-term and mid-term dysphagia. The present meta-analysis was designed to compare the outcome between mesh-reinforced and primary hiatal hernia repair. The databases of Medline, EMBASE, and the Cochrane Library were searched; only randomized controlled trials entered the meta-analytical model. Anatomic recurrence documented by barium oesophagography was defined as the primary outcome endpoint. Three randomized controlled trials reporting the outcomes of 267 patients were identified. The follow-up period ranged between 6 and 12 months. The weighted mean recurrence rates after primary and mesh-reinforced hiatoplasty were 24.3% and 5.8%, respectively. Pooled analysis demonstrated increased risk of recurrence in primary hiatal closure (odds ratio, 4.2; 95% confidence interval, 1.8-9.5; P=0.001). Mesh-reinforced hiatal hernia repair is associated with an approximately 4-fold decreased risk of recurrence in comparison with simple repair. The long-term results of mesh-augmented hiatal closure remain to be investigated.
authors.affiliation: Department of General and Visceral Surgery, Center for Minimally Invasive Surgery, Hospital Neuwerk, Mönchengladbach, Germany. stavros.antoniou@hotmail.com
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.forename: Oliver O
authors.initials: OO
authors.lastname: Koch
authors.forename: Rudolph
authors.initials: R
authors.lastname: Pointner
authors.forename: Frank A
authors.initials: FA
authors.lastname: Granderath
mesh_terms: D000368:Aged; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D055502:Secondary Prevention; D013526:Surgical Mesh; D016896:Treatment Outcome