Five Year Follow-up of a Randomized Controlled Trial of Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Versus Nonabsorbable Mesh

被引:86
作者
Watson, David, I [1 ]
Thompson, Sarah K. [1 ]
Devitt, Peter G. [2 ]
Aly, Ahmad [4 ]
Irvine, Tanya [1 ]
Woods, Simon D. [3 ]
Gan, Susan [1 ]
Game, Philip A. [2 ]
Jamieson, Glyn G. [2 ]
机构
[1] Flinders Univ S Australia, Flinders Med Ctr, Discipline Surg, Bedford Pk, SA, Australia
[2] Univ Adelaide, Royal Adelaide Hosp, Discipline Surg, Adelaide, SA, Australia
[3] Cabrini Hosp, Malvern, Vic, Australia
[4] Univ Melbourne, Austin Hosp, Dept Surg, Heidelberg, Vic, Australia
基金
英国医学研究理事会;
关键词
hiatus hernia; laparoscopy; mesh repair; randomized controlled trial; NISSEN FUNDOPLICATION; BIOLOGIC PROSTHESIS; RECURRENCE; MULTICENTER;
D O I
10.1097/SLA.0000000000003734
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair. Summary of Background Data: Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair. Methods: Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years. Results: 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P= 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh. Conclusions: No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.
引用
收藏
页码:241 / 247
页数:7
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