Tension-free meshversussuture-alone cruroplasty in antireflux surgery: a randomized, double-blind clinical trial

被引:39
作者
Analatos, A. [1 ,2 ,4 ,5 ]
Hakanson, B. S. [3 ,6 ]
Lundell, L. [1 ,2 ,7 ]
Lindblad, M. [1 ,2 ]
Thorell, A. [3 ,6 ]
机构
[1] Karolinska Inst, Dept Clin Intervent & Technol CLINTEC, Stockholm, Sweden
[2] Karolinska Univ Hosp, Ctr Digest Dis, Stockholm, Sweden
[3] Ersta Hosp, Dept Surg, POB 4619, SE-11691 Stockholm, Sweden
[4] Nykoping Hosp, Dept Surg, Nykoping, Sweden
[5] Uppsala Univ, Ctr Clin Res Sormland, Uppsala, Sweden
[6] Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Danderyd, Sweden
[7] Odense Univ Hosp, Dept Surg, Odense, Denmark
关键词
PARAESOPHAGEAL HERNIA REPAIR; BIOLOGIC PROSTHESIS; HIATAL CLOSURE; MESH; FUNDOPLICATION; RECURRENCE; COMPLICATIONS; METAANALYSIS; MULTICENTER; VALIDATION;
D O I
10.1002/bjs.11917
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Antireflux surgery is effective for the treatment of gastro-oesophageal reflux disease (GORD) but recurrence of hiatal hernia remains a challenge. In other types of hernia repair, use of mesh is associated with reduced recurrence rates. The aim of this study was to compare the use of meshversussutures alone for the repair of hiatal hernia in laparoscopic antireflux surgery. Methods Patients undergoing laparoscopic Nissen fundoplication for GORD between January 2006 and December 2010 were allocated randomly to closure of the diaphragmatic hiatus with crural sutures or non-absorbable polytetrafluoroethylene mesh (CruraSoft (R)). The primary outcome was recurrence of hiatal hernia, as determined by barium swallow study 12 months after surgery. Secondary outcomes were: intraoperative and postoperative complications, use of antireflux medication, postoperative oesophageal acid exposure, quality of life, dysphagia and duration of hospital stay. Results Some 77 patients were randomized to the suture technique and 82 patients underwent mesh repair. At 1 year, the hiatal hernia had recurred in six of 64 patients (9 per cent) in the mesh group and two of 64 (3 per cent) in the suture group (P = 0 center dot 144). Reflux symptoms, use of proton pump inhibitors and oesophageal acid exposure did not differ between the groups. At 3 years, recurrence rates were 13 and 10 per cent in the mesh and suture groups respectively (P = 0 center dot 692). Dysphagia scores decreased in both groups, but more patients had dysphagia for solid food after mesh closure (P = 0 center dot 013). Quality-of-life scores were comparable between the groups. Conclusion Tension-free crural repair with non-absorbable mesh does not reduce the incidence of recurrent hiatal hernia compared with use of sutures alone in patients undergoing laparoscopic fundoplication. NCT03730233 ( ).
引用
收藏
页码:1731 / 1740
页数:10
相关论文
共 33 条
[31]   Five Year Follow-up of a Randomized Controlled Trial of Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Versus Nonabsorbable Mesh [J].
Watson, David, I ;
Thompson, Sarah K. ;
Devitt, Peter G. ;
Aly, Ahmad ;
Irvine, Tanya ;
Woods, Simon D. ;
Gan, Susan ;
Game, Philip A. ;
Jamieson, Glyn G. .
ANNALS OF SURGERY, 2020, 272 (02) :241-247
[32]   Open Preperitoneal Techniques versus Lichtenstein Repair for elective Inguinal Hernias [J].
Willaert, Wouter ;
De Bacquer, Dirk ;
Rogiers, Xavier ;
Troisi, Roberto ;
Berrevoet, Frederik .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2012, (07)
[33]   Systematic review and meta-analysis of laparoscopic mesh versus suture repair of hiatus hernia: objective and subjective outcomes [J].
Zhang, Chao ;
Liu, Diangang ;
Li, Fei ;
Watson, David I. ;
Gao, Xiang ;
Koetje, Jan H. ;
Luo, Tao ;
Yan, Chao ;
Du, Xing ;
Wang, Zhonggao .
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2017, 31 (12) :4913-4922