A collective review of biological versus synthetic mesh-reinforced cruroplasty during laparoscopic Nissen fundoplication

P. S. S. Castelijns, J. E. H. Ponten, M. C. G. van de Poll, S. W. Nienhuijs, J. F. Smulders*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

6 Citations (Web of Science)

Abstract

Background: Laparoscopic cruroplasty and fundoplication have become the gold standard in the treatment of hiatal hernia and gastro-oesophageal reflux disease (GERD). The use of a mesh-reinforcement of the cruroplasty has been proven effective; although, there is a lack of evidence considering which type of mesh is superior. The aim of this study was to compare recurrence rates after mesh reinforced cruroplasty using biological versus synthetic meshes. Methods: We performed a systematic review of all clinical trials published between January 2004 and September 2015 describing the application of a mesh in the hiatal hernia repair during Nissen fundoplication for both GERD and hiatal hernia. The primary outcome was the recurrence rate, and secondary outcomes were complication rate, mortality and symptomatic outcome. Results: We included 16 studies and extracted data regarding 1089 mesh operated patients of whom 385 received a biological mesh and 704 a synthetic mesh. The mean follow-up was 53.4 months. The recurrence rate in the synthetic mesh group was 6.8% compared to 16.1% in the biological mesh group (P < 0.05). The complication rate was 5.1% and 4.6% (P = 0.694), respectively, and there were 12 mesh-related complications. No mesh-related mortality was reported. Conclusion: Mesh reinforcement of hiatal hernia repair seems safe in the short-term follow-up. The available literature suggests no clear advantage of biological over synthetic meshes. Regarding cost-efficiency and short-term results, the use of synthetic nonabsorbable meshes might be advocated.
Original languageEnglish
Pages (from-to)87-94
Number of pages8
JournalJournal of minimal access surgery
Volume14
Issue number2
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • Biologic
  • cruroplasty
  • hiatal hernia
  • laparoscopy
  • mesh
  • Nissen fundoplication
  • synthetic
  • HIATAL-HERNIA REPAIR
  • GASTROESOPHAGEAL-REFLUX DISEASE
  • PARAESOPHAGEAL HERNIA
  • RANDOMIZED-TRIAL
  • PROSTHETIC REINFORCEMENT
  • POLYPROPYLENE MESH
  • REDUCES RECURRENCE
  • ANTIREFLUX SURGERY
  • FOLLOW-UP
  • CLOSURE

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