Introduction: Large sliding Hiatal Hernia (HH) is associated with an exceedingly high incidence of recurrence
after surgery. An ongoing controversy exists while managing it regarding the best surgical technique. We aimed to
compare laparoscopic mesh hernioplasty to laparoscopic suture crurorraphy for a large HH in terms of the diseasespecific
Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score, HH recurrence, and
postoperative complications.
Patients and methods: This prospective study was conducted between December 2019 to August 2023 on
patients diagnosed with a large sliding HH and refractory GERD undergoing either laparoscopic suture crurorraphy
(Group A) or laparoscopic mesh hernioplasty using the Symbotex™ composite mesh (Group B). Patients were
assessed for GERD-HRQL score, postoperative complications, recurrence of symptoms, or hernia.
Results: Throughout the study period, 34 patients with refractory GERD and large HH were included. Both
techniques were comparable with no statistically significant difference in the operative time (78.7 ±18.9 min vs
81.1 ± 17.4, p=0.54), hospital stay (2.8 ± 0.6 days vs 2.6 ± 0.9, p=0.42), and postoperative complications (5 vs
6, p=1). Mesh placement was associated with a statistically significant lower rate of recurrence (P=0.042). GERD
HRQL score was significantly lower in the mesh hernioplasty group at 6 months (p=0.042), 12 months (p=0.036)
and 18 months (p=00.023).
Conclusion: Mesh placement significantly reduced the recurrence of a large HH and was associated with more
improvement in the GERD HRQL score.