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Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis.
Surg Endosc. 2023 03; 37(3):2295-2303.SE

Abstract

INTRODUCTION

The use of bioabsorbable mesh at the hiatus is controversial. Long-term data are scant. We evaluated the world literature and performed a meta-analysis to determine if these meshes were effective in reducing recurrence.

METHODS

A literature search was performed using PubMed, MEDLINE, and ClinicalKey. We evaluated articles reporting on both Bio-A™ (polyglycolic acid:trimethylene carbonate-PGA:TMC) and Phasix™ (poly-4-hydroxybutyrate-P4HB) used at the hiatus. The DerSimonian-Laird random effects model was used to estimate the overall pooled treatment effect along with a 95% confidence interval (CI). Similar analysis was conducted to compare the clinical outcomes, i.e., recurrence rate, mean surgical time, mean hospital stays and mean follow-up duration between non-Mesh and Mesh group. The I2 statistic was computed to assess the heterogeneity in effect sizes across the studies.

RESULTS

A total of 21 studies (12 mesh studies with 963 subjects and 9 non-mesh studies with 617 subjects) were included to conduct the meta-analysis. There was one article reporting outcomes on P4HB mesh (73 subjects) and 11 on PGA:TMC mesh (890 subjects). The bioabsorbable mesh group had a significantly lower recurrence rate compared to the non-mesh group (8% vs. 18%; 95%CI 0.08-0.17), pooled p-value < 0.0001. Surgery time was shorter in the mesh group compared to the non-mesh group (136.4 min vs. 150 min) but not statistically significant (p = 0.54). There tended to be a more extended follow-up period after surgery in the non-mesh group compared to the mesh group (27 vs. 25.8 months, range 10.8-54 months); but not statistically significant (ES: 27.4; 95%CI 21.6-33.3; p = 0.92).

CONCLUSIONS

Hiatal hernia repair with bioabsorbable mesh is more effective at reducing hernia recurrence rate in the mid-term than simple suture cruroplasty. Further studies investigating the long-term outcomes and P4HB mesh are needed.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Department of Surgery, Texas Tech University Health Sciences Center El Paso, 1700 N. Mesa, El Paso, TX, 79902, USA. bclappmd@gmail.com.

Department of Surgery, Texas Tech University Health Sciences Center El Paso, 1700 N. Mesa, El Paso, TX, 79902, USA.

Department of Surgery, Texas Tech University Health Sciences Center El Paso, 1700 N. Mesa, El Paso, TX, 79902, USA.

Department of Surgery, Texas Tech University Health Sciences Center El Paso, 1700 N. Mesa, El Paso, TX, 79902, USA.

Department of Surgery, Texas Tech University Health Sciences Center El Paso, 1700 N. Mesa, El Paso, TX, 79902, USA.

Department of Surgery, Texas Tech University Health Sciences Center El Paso, 1700 N. Mesa, El Paso, TX, 79902, USA.

Department of Surgery, Mayo Clinic, Rochester, MN, USA.

Department of Surgery, Texas Tech University Health Sciences Center El Paso, 1700 N. Mesa, El Paso, TX, 79902, USA.

MeSH

HumansHernia, HiatalAbsorbable ImplantsSurgical MeshLaparoscopyRecurrenceHerniorrhaphyTreatment OutcomeRetrospective Studies

Pub Type(s)

Meta-Analysis

Journal Article

Language

eng

PubMed ID

35951120

Citation

Clapp, Benjamin, et al. "Does Bioabsorbable Mesh Reduce Hiatal Hernia Recurrence Rates? a Meta-analysis." Surgical Endoscopy, vol. 37, no. 3, 2023, pp. 2295-2303.

Clapp B, Kara AM, Nguyen-Lee PJ, et al. Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis. Surg Endosc. 2023;37(3):2295-2303.

Clapp, B., Kara, A. M., Nguyen-Lee, P. J., Annabi, H. M., Alvarado, L., Marr, J. D., Ghanem, O. M., & Davis, B. (2023). Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis. Surgical Endoscopy, 37(3), 2295-2303. https://doi.org/10.1007/s00464-022-09514-1

Clapp B, et al. Does Bioabsorbable Mesh Reduce Hiatal Hernia Recurrence Rates? a Meta-analysis. Surg Endosc. 2023;37(3):2295-2303. PubMed PMID: 35951120.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Does bioabsorbable mesh reduce hiatal hernia recurrence rates? A meta-analysis. AU - Clapp,Benjamin, AU - Kara,Ali M, AU - Nguyen-Lee,Paul J, AU - Annabi,Hani M, AU - Alvarado,Luis, AU - Marr,John D, AU - Ghanem,Omar M, AU - Davis,Brian, Y1 - 2022/08/11/ PY - 2022/04/01/received PY - 2022/07/26/accepted PY - 2022/8/12/pubmed PY - 2023/3/21/medline PY - 2022/8/11/entrez KW - Bioabsorbable mesh KW - Hernia KW - Hiatal hernia repair KW - Laparoscopy KW - Mesh repair KW - Recurrence SP - 2295 EP - 2303 JF - Surgical endoscopy JO - Surg Endosc VL - 37 IS - 3 N2 - INTRODUCTION: The use of bioabsorbable mesh at the hiatus is controversial. Long-term data are scant. We evaluated the world literature and performed a meta-analysis to determine if these meshes were effective in reducing recurrence. METHODS: A literature search was performed using PubMed, MEDLINE, and ClinicalKey. We evaluated articles reporting on both Bio-A™ (polyglycolic acid:trimethylene carbonate-PGA:TMC) and Phasix™ (poly-4-hydroxybutyrate-P4HB) used at the hiatus. The DerSimonian-Laird random effects model was used to estimate the overall pooled treatment effect along with a 95% confidence interval (CI). Similar analysis was conducted to compare the clinical outcomes, i.e., recurrence rate, mean surgical time, mean hospital stays and mean follow-up duration between non-Mesh and Mesh group. The I2 statistic was computed to assess the heterogeneity in effect sizes across the studies. RESULTS: A total of 21 studies (12 mesh studies with 963 subjects and 9 non-mesh studies with 617 subjects) were included to conduct the meta-analysis. There was one article reporting outcomes on P4HB mesh (73 subjects) and 11 on PGA:TMC mesh (890 subjects). The bioabsorbable mesh group had a significantly lower recurrence rate compared to the non-mesh group (8% vs. 18%; 95%CI 0.08-0.17), pooled p-value < 0.0001. Surgery time was shorter in the mesh group compared to the non-mesh group (136.4 min vs. 150 min) but not statistically significant (p = 0.54). There tended to be a more extended follow-up period after surgery in the non-mesh group compared to the mesh group (27 vs. 25.8 months, range 10.8-54 months); but not statistically significant (ES: 27.4; 95%CI 21.6-33.3; p = 0.92). CONCLUSIONS: Hiatal hernia repair with bioabsorbable mesh is more effective at reducing hernia recurrence rate in the mid-term than simple suture cruroplasty. Further studies investigating the long-term outcomes and P4HB mesh are needed. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/35951120/Does_bioabsorbable_mesh_reduce_hiatal_hernia_recurrence_rates_A_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -