Background
Some patients with large hiatal hernias who undergo laparoscopic hiatal cruroplasty show recurrence of hernia and/or symptoms. We are studying the outcome of laparoscopic mesh hiatal hernioplasty versus suture cruroplasty for the repair of large hiatal hernias more than 4 cm.
Patients and methods
This is a prospective, randomized, comparative study that was conducted at the General Surgery Department of Ain Shams University Hospitals during the period from February 2019 to February 2021. The study included 20 patients with large hiatal hernia defect more than 4 cm in whom laparoscopic hiatal hernia repair was indicated. The aim of the study was to compare between feasibility, safety, and efficacy of laparoscopic mesh hiatal hernioplasty and laparoscopic hiatal hernia suture cruroplasty.
Results
Laparoscopic mesh hiatal hernioplasty for large hiatal hernia more than 4 cm has higher operative time (94 ± 15.6 min with =0.0001) and more intraoperative bleeding (130 ± 66.8 ml with =0,002) than laparoscopic hiatal hernia cruroplasty (63 ± 8.2 min and 64 ± 23.2 ml). But has a better outcome regarding quality of life (at 12 months 1.8 ± 0.9 vs. 2.3 ± 0.5 with a =0.24) incidence of symptoms recurrence (at 12 months, 20 vs. 30% with a =0.605) and hernial recurrence (at 12 months 10 vs. 30% with a =0.264).
Conclusion
Laparoscopic mesh hiatal hernioplasty results in improvement of symptoms, quality of life, and decrease in hernia recurrence, but evidence supporting routine use of mesh cruroplasty is low. The mesh should be used according to surgeon preference until additional studies of long-term follow-up are available.