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Five Year Follow-up of a Randomized Controlled Trial of Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Versus Nonabsorbable Mesh.
- Source :
-
Annals of surgery [Ann Surg] 2020 Aug; Vol. 272 (2), pp. 241-247. - Publication Year :
- 2020
-
Abstract
- Objective: To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair.<br />Summary of Background Data: Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair.<br />Methods: Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years.<br />Results: 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh.<br />Conclusions: No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.
- Subjects :
- Absorbable Implants
Adult
Analysis of Variance
Australia
Chi-Square Distribution
Double-Blind Method
Female
Follow-Up Studies
Hernia, Hiatal diagnostic imaging
Herniorrhaphy adverse effects
Humans
Laparoscopy adverse effects
Male
Middle Aged
Prospective Studies
Recurrence
Reoperation methods
Risk Assessment
Severity of Illness Index
Time Factors
Treatment Outcome
Wound Healing physiology
Hernia, Hiatal surgery
Herniorrhaphy methods
Laparoscopy methods
Surgical Mesh adverse effects
Suture Techniques
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1140
- Volume :
- 272
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 32675536
- Full Text :
- https://doi.org/10.1097/SLA.0000000000003734