The Role of Biologic Mesh and Fundoplication in the Surgical Management of Hiatal Hernias: A Multicenter Evaluation.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Digestive Surgery Pub Date : 2023-01-01 Epub Date: 2023-07-26 DOI:10.1159/000533186

Cassandra Mohr, Hailie Ciomperlik, Naila Dhanani, Oscar A Olavarria, Craig Hannon, William Hope, Scott Roth, Mike K Liang, Julie L Holihan

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引用次数: 0

Abstract

Introduction: Hiatal hernia repair is associated with substantial recurrence of both hiatal hernia and symptoms of gastroesophageal reflux (GER). While small randomized controlled trials demonstrate limited differences in outcomes with use of mesh or fundoplication type, uncertainty remains.

Methods: A multicenter, retrospective review of patients undergoing surgical treatment of hiatal hernias between 2015 and 2020 was performed. Patients with mesh and with suture-only repair were compared, and partial versus complete fundoplication was compared. Primary outcomes were hernia recurrence and occurrence of postoperative GER symptoms and dysphagia. Multivariable regression was performed to assess the effect of each intervention on clinical outcomes.

Results: A total of 453 patients from four sites were followed for a median (IQR) of 17 (13) months. On multivariate analysis, mesh had no impact on hernia recurrence (odds ratio 0.993, 95% CI: 0.53-1.87, p = 0.982), and fundoplication type did not impact recurrence of postoperative GER symptoms (complete: odds ratio 0.607, 95% CI: 0.33-1.12, p = 0.112) or dysphagia (complete: odds ratio 1.17, 95% CI: 0.56-2.43, p = 0.677).

Conclusion: During hiatal hernia repair, mesh and fundoplication type do not appear to have substantial impact on GER symptoms, dysphagia, or hernia recurrence. This multicenter study provides real-world evidence to support the findings of small RCTs.

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生物网状物和底折叠术在先天性疝外科治疗中的作用：多中心评估。

引言：裂孔疝修补术与裂孔疝和胃食管反流（GER）症状的大量复发有关。虽然小型随机对照试验表明，使用网状物或胃底折叠术类型的结果差异有限，但仍存在不确定性。方法：对2015年至2020年间接受裂孔疝手术治疗的患者进行多中心回顾性审查。比较网状和仅缝合修复的患者，并比较部分和完全胃底折叠术。主要结果是疝复发、术后GER症状和吞咽困难的发生。进行多变量回归以评估每种干预措施对临床结果的影响。结果：来自四个部位的453名患者接受了中位（IQR）17（13）个月的随访。在多变量分析中，网状物对疝复发没有影响（比值比0.993，95%CI:0.53-1.87，p=0.982），而胃底折叠术类型对术后GER症状的复发也没有影响（完全：比值比0.607，95%CI:0.33-1.12，p=0.112）或吞咽困难（完全：优势比1.17，95%CI:0.56-2.43，p=0.677），网状物和胃底折叠类型似乎对GER症状、吞咽困难或疝复发没有实质性影响。这项多中心研究提供了真实世界的证据来支持小型随机对照试验的发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.