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Sutured Versus Mesh-augmented Hiatus Hernia Repair

医学 外科 外科手术网 荟萃分析 随机对照试验 置信区间 纤维接头 优势比 裂孔疝 疝修补术 内科学 回流 疾病
作者
Josipa Petric,Tim Bright,David S. Liu,Melissa Wee Yun,David I. Watson
出处
期刊:Annals of Surgery [Lippincott Williams & Wilkins]
卷期号:275 (1): e45-e51 被引量:47
标识
DOI:10.1097/sla.0000000000004902
摘要

Objective: This meta-analysis systematically reviewed published randomized control trials comparing sutured versus mesh-augmented hiatus hernia (HH) repair. Our primary endpoint was HH recurrence at short- and long-term follow-up. Secondary endpoints were: surgical complications, operative times, dysphagia and quality of life. Summary Background Data: Repair of large HHs is increasingly being performed. However, there is no consensus for the optimal technique for hiatal closure between sutured versus mesh-augmented (absorbable or nonabsorbable) repair. Methods: A systematic review of Medline, Scopus (which encompassed Embase), Cochrane Central Register of Controlled Trials, Web of Science, and PubMed was performed to identify relevant studies comparing mesh-augmented versus sutured HH repair. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. Results: Seven randomized control trials were found which compared mesh-augmented (nonabsorbable mesh: n = 296; absorbable mesh: n = 92) with sutured repair (n = 347). There were no significant differences for short-term hernia recurrence (defined as 6–12 months, 10.1% mesh vs 15.5% sutured, P = 0.22), long-term hernia recurrence (defined as 3–5 years, 30.7% mesh vs 31.3% sutured, P = 0.69), functional outcomes and patient satisfaction. The only statistically significant difference was that the mesh repair required a longer operation time ( P = 0.05, OR 2.33, 95% confidence interval 0.03–24.69). Conclusions: Mesh repair for HH does not offer any advantage over sutured hiatal closure. As both techniques deliver good and comparable clinical outcomes, a suture only technique is still an appropriate approach.
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