Could Mesh Placement Solve the Problem of High Radiological and Symptomatic Recurrence in Patients with a Large Sliding Hiatal Hernia? A Prospective Comparative Study

Abstract

Introduction: Large sliding Hiatal Hernia (HH) is associated with an exceedingly high incidence of recurrenceafter surgery. An ongoing controversy exists while managing it regarding the best surgical technique. We aimed tocompare laparoscopic mesh hernioplasty to laparoscopic suture crurorraphy for a large HH in terms of the diseasespecificGastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score, HH recurrence, andpostoperative complications.Patients and methods: This prospective study was conducted between December 2019 to August 2023 onpatients diagnosed with a large sliding HH and refractory GERD undergoing either laparoscopic suture crurorraphy(Group A) or laparoscopic mesh hernioplasty using the Symbotex™ composite mesh (Group B). Patients wereassessed for GERD-HRQL score, postoperative complications, recurrence of symptoms, or hernia.Results: Throughout the study period, 34 patients with refractory GERD and large HH were included. Bothtechniques were comparable with no statistically significant difference in the operative time (78.7 ±18.9 min vs81.1 ± 17.4, p=0.54), hospital stay (2.8 ± 0.6 days vs 2.6 ± 0.9, p=0.42), and postoperative complications (5 vs6, p=1). Mesh placement was associated with a statistically significant lower rate of recurrence (P=0.042). GERDHRQL score was significantly lower in the mesh hernioplasty group at 6 months (p=0.042), 12 months (p=0.036)and 18 months (p=00.023).Conclusion: Mesh placement significantly reduced the recurrence of a large HH and was associated with moreimprovement in the GERD HRQL score.