The controversial impact of mesh augmentation on surgical outcomes in hiatal hernia repair: a systematic review and meta-analysis.
Eleni Kitsou, Evgenia Mela, Konstantinos Saliaris et al.
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In 30 seconds
This systematic review and meta-analysis compared mesh-augmented with primary suture repair for hiatal hernia in seven randomized controlled trials and three prospective cohort studies, comprising 1,472 patients with recurrence data. Mesh reinforcement was not associated with a statistically significant difference in recurrence (OR, 0.51; 95% CI, 0.25-1.03) or overall postoperative complications (OR, 1.07; 95% CI, 0.6-1.92). Reoperation rates were also comparable. The authors conclude that available evidence does not show reduced recurrence or increased postoperative complications with mesh, while noting heterogeneity and wide prediction intervals.
Key findings
- Recurrence did not differ significantly between mesh and suture repair (OR, 0.51; 95% CI, 0.25-1.03; 95% PI, 0.08-3.35; I 2 = 49.6%).
- Overall postoperative complications were comparable (OR, 1.07; 95% CI, 0.6-1.92; 95% PI, 0.32-3.6; I 2 = 8.9%).
- Reoperation rates did not differ significantly (OR, 0.43; 95% CI, 0.17-1.11; 95% PI, 0.12-1.50; I 2 = 0.0%).
Why it matters
Mesh reinforcement is used to address concern about recurrence after hiatal hernia repair, but this synthesis found no significant recurrence advantage over suture repair and no significant difference in postoperative complications or reoperation. The findings help frame the uncertainty around routine mesh use: pooled estimates do not establish a clear benefit, and prediction intervals indicate that results may vary across settings.
What to keep in mind
The analysis included a limited number of randomized trials and prospective cohorts, with moderate heterogeneity for recurrence and wide prediction intervals. The authors call for high-quality trials with standardized techniques and long-term follow-up.