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Does the use of bioabsorbable mesh for hiatal hernia repair at the time of bariatric surgery reduce recurrence rates? A meta-analysis

Published:August 09, 2022DOI:https://doi.org/10.1016/j.soard.2022.08.004

      Highlights

      • Our meta-analysis included twelve studies with 1,351 patients.
      • We found that bioabsorbable mesh reduced hiatal hernia recurrence rates from 14% to 2% with similar operative time and length of stay.
      • The follow-up time was similar between the mesh and non-mesh groups and was 28.8 months.
      • Our findings suggest that bioabsorbable mesh should be used to reinforce hiatal hernia repairs at the time of bariatric surgery.

      Abstract

      Background

      Anywhere from 16% to 37% of patients undergoing bariatric and metabolic surgery are estimated to have a hiatal hernia. To address the lack of long-term data showing the efficacy of bioabsorbable mesh in reducing the recurrence of hiatal hernia in patients who undergo bariatric surgery, we evaluated the world literature and performed a meta-analysis.

      Objective

      To evaluate hiatal hernia recurrence rates after placement of bioabsorbable mesh in bariatric patients.

      Setting

      Meta-analysis of world literature.

      Methods

      We performed a literature search using PubMed and MEDLINE with search terms including “hiatal hernia recurrence,” “bariatric surgery,” “bioabsorbable mesh,” “Gore BIO-A,” and “trimethylene carbonate.” Analysis was conducted to compare surgical time, length of stay, recurrence rate, hernia size, and changes in body mass index before and after surgery between mesh-group (MG) and nonmesh (NM) patients. The meta-analysis was described using standardized mean difference, weighted mean difference, effect size, and 95% confidence interval (CI). An I2 statistic was computed to assess heterogeneity.

      Results

      Twelve studies with 1351 patients were included in our meta-analysis. Four studies had both an MG and an NM group. There were 668 patients in the MG and 683 patients in the NM group. Hernia size noted in the NM group (7 cm2) was compared with that in the MG (6.5 cm2) (95% CI: 3.89–9.14; P = .86). The MG had fewer recurrences than the NM group (effect size, 2% versus 14%; 95% CI: –.26 to –.02; P = .027). The average follow-up was 28.8 months for the MG and 32.8 months for the NM group.

      Conclusion

      Repair with bioabsorbable mesh at the time of the index bariatric surgery is more effective at reducing the recurrence rate of hiatal hernia than suture cruroplasty. Further studies investigating the long-term outcomes of bioabsorbable mesh placed at the time of bariatric surgery are needed.

      Keywords

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