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Outcomes Following Laparoscopic Hiatal Hernia Repair with Mesh: A Comparison of Biologic and Biosynthetic Mesh
Lava Y. Patel, Matthew E. Gitelis*, John G. Linn, Stephen P. Haggerty, Woody Denham, Michael Ujiki
Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston, IL
Introduction: Mesh is commonly used during laparoscopic hiatal repair as a means to decrease recurrence. Permanent mesh has fallen out of favor due to associated complications including high rates of esophageal violation and fistula formation. Absorbable mesh has been shown to be more effective in preventing recurrence with fewer associated complications. Many absorbable mesh types exist, such as true biologic xenografts and newer biosynthetic mesh products. In this study we compared outcomes between two popular options including a biologic (Surgisis) and biosynthetic (Bio-A) mesh.
Methods: A retrospective review of a prospectively maintained gastro-esophageal database (n=654) at our institution was performed. In this study, 148 patients were identified that underwent laparoscopic hiatal hernia repair with mesh. Of these cases, 94 patients had a repair performed using Surgisis and 54 using Bio-A. Median follow up was 11 months in the Surgisis group and 7 months in the Bio-A group. Recurrence was defined as having positive findings of hiatal hernia on postoperative imaging.
Results: Mean age was 70 ± 12 years in the Surgisis group and 72 ± 11 years in the Bio-A group (p=0.403). There was no statistically significant difference in gender (17% male vs 26% male), body mass index (29 ± 5 vs 28 ± 5), or smoking status (7% active vs 2% active). The mean reported symptom duration was 6.2 ± 6.6 years in the Surgisis group and 7.3 ± 4.8 years in the Bio-A group. Mean operating room time was significantly longer at 155 ± 45 min in the Surgisis group versus 140 ± 44 min in the Bio-A group (p=0.049). Mean length of stay was similar between groups (3.3 ± 3.6 days vs 3.3 ± 6.3 day; p=0.959). There was a significantly higher visual analog pain score reported at discharge in the Surgisis group (3.5 ± 2.9 vs 2.0 ± 2.0; p=0.004). 96% of patients in the Surgisis group and 94% of patients in the Bio-A group reported resolution of GERD symptoms on routine follow up post-operatively. Significantly more patients reported taking proton pump inhibitors postoperatively in the Surgisis group (26% vs 19%; p=0.048). During the follow-up period, the hiatal hernia recurrence rate was 23% in the Surgisis group and 9% in the Bio-A group (p=0.032). There was no difference in Dysphagia, Reflux Severity Index, or GERD quality of life scores at 3 weeks or 6 months postoperatively between the two groups.
Conclusion: In our experience, use of biosynthetic mesh to buttress crural repair resulted in decreased operative times, less pain at discharge, and decreased proton pump inhibitor use post-operatively. These patients also experienced significantly less rates of recurrence. Small sample size and duration of follow-up may contribute to these findings and further investigation with prospective comparison is necessary.
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