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1000
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Abstract/Summary
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<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Introduction</jats:title>
<jats:p>Surgical treatment of type I hiatal sliding hernias aims to control the gastroesophageal reflux symptoms and prevention of hernia recurrence. Usually, a cruroplasty is performed to narrow the hiatal orifice. Here, it remains controversial if a mesh reinforcement of the cruroplasty should be performed, since benefits as well as mesh-associated complications have been described.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>We performed a propensity-score matching analysis with data derived from the Herniamed registry comparing patients undergoing laparoscopic type I hiatal hernia repair with and without synthetic mesh. We analyzed perioperative, intraoperative, and postoperative data including data derived from the 1-year follow-up in the registry.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>6.533 patients with an axial, type I hiatal hernia and gastroesophageal reflux are included in this analysis. Mesh augmentation of the hiatoplasty was performed in <jats:italic>n</jats:italic> = 1.252/6.533 (19.2%) of patients. The defect size in the subgroup of patients with mesh augmentation was with mean 16.3 cm<jats:sup>2</jats:sup> [14.5; 18.2] significantly larger as in the subgroups without mesh augmentation with 10.8 cm<jats:sup>2</jats:sup> [8.7; 12.9]; (<jats:italic>p</jats:italic> < 0.001). In patients with mesh hiatoplasty <jats:italic>n</jats:italic> = 479 (38.3%) Nissen and <jats:italic>n</jats:italic> = 773 (61.7%) Toupet fundoplications are performed. 1.207 matched pairs could be analyzed. The mean defect size after matching was with 15.9 cm<jats:sup>2</jats:sup> comparable in both groups. A significant association was seen regarding recurrence (4.72% mesh vs. 7.29% non-mesh hiatoplasty, <jats:italic>p</jats:italic> = 0.012). The same relation can be seen for pain on exertion (8.78% vs 12.10%; <jats:italic>p</jats:italic> = 0.014) and pain requiring treatment (6.13% vs 9.11%; <jats:italic>p</jats:italic> = 0.010). All other outcome parameter showed no significant correlation.</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Our data demonstrate that mesh-reinforced laparoscopic type I hiatal hernia repair in larger defects is associated with significantly lower rates for recurrence, pain on exertion and pain requiring treatment.</jats:p>
</jats:sec>
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1000
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Hinweis
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DeepGreen-ID: 5f456fd1f97e4e24989538119d710ae8 ; metadata provieded by: DeepGreen (https://www.oa-deepgreen.de/api/v1/), LIVIVO search scope life sciences (http://z3950.zbmed.de:6210/livivo), Crossref Unified Resource API (https://api.crossref.org/swagger-ui/index.html), to.science.api (https://frl.publisso.de/), ZDB JSON-API (beta) (https://zeitschriftendatenbank.de/api/), lobid - Dateninfrastruktur für Bibliotheken (https://lobid.org/resources/search)
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