title: A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair.
abstract: BACKGROUND
  Equipoise exists regarding whether mesh cruroplasty during laparoscopic large hiatal hernia repair improves symptomatic outcomes compared with suture repair.
  
  
  METHODS
  Systematic literature review (MEDLINE and EMBASE) identified 13 studies (1,194 patients; 521 suture and 673 mesh) comparing mesh versus suture cruroplasty during laparoscopic repair of large hiatal hernia. We abstracted data regarding symptom assessment, objective recurrence, and reoperation and performed meta-analysis.
  
  
  CONCLUSIONS
  The majority of studies reported significant symptom improvement. Data were insufficient to evaluate symptomatic versus asymptomatic recurrence. Time to evaluation was skewed toward longer follow-up after suture cruroplasty. Odds of recurrence (odds ratio .51, 95% confidence interval .30 to .87; overall P = .014) but not need for reoperation (odds ratio .42, 95% confidence interval .13 to 1.37; overall P = .149) were less after mesh cruroplasty. Quality of evidence supporting routine use of mesh cruroplasty is low. Mesh should be used at surgeon discretion until additional studies evaluating symptomatic outcomes, quality of life, and long-term recurrence are available.
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA, USA.
authors.forename: Vernissia
authors.initials: V
authors.lastname: Tam
authors.affiliation: Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.affiliation: Division of Thoracic and Foregut Surgery, Department of Cardiothoracic Surgery, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA, USA. Electronic address: nasonks@upmc.edu.
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
mesh_terms: D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: Fundoplication; Hiatal hernia; Recurrence; Surgical mesh; Symptom assessment; Treatment failure