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Salehi N, Marshall T, Christianson B, Al Asadi H, Najah H, Lee-Saxton YJ, Tumati A, Safe P, Gavlin A, Chatterji M, Finnerty BM, Fahey TJ, Zarnegar R. Comparative anatomic and symptomatic recurrence outcomes of diaphragmatic suture cruroplasty versus biosynthetic mesh reinforcement in robotic hiatal and paraesophageal hernia repair. Surg Endosc 2024:10.1007/s00464-024-11257-0. [PMID: 39271508 DOI: 10.1007/s00464-024-11257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 08/31/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Hiatal and paraesophageal hernia (HH/PEH) recurrence is the most common cause of failure after gastroesophageal anti-reflux surgery. Crural reinforcement with mesh has been suggested to address this issue, but its efficacy remains debated. In this study, we aimed to determine the impact of biosynthetic mesh reinforcement compared to suture cruroplasty on anatomic and symptomatic hernia recurrence. METHOD Data of patients who underwent robotic HH/PEH repair with suture cruroplasty with or without biosynthetic mesh reinforcement between January 2012 and April 2024 were retrospectively reviewed. Gastroesophageal reflux disease symptoms and anatomic hernia recurrence were assessed at short-term (3 months to 1 year) and longer-term (≥ 1 year) follow-up. Symptomatic hernia recurrence was defined as having both anatomic recurrence and symptoms. RESULTS Out of the 503 patients in the study, 308 had undergone biosynthetic mesh repair, while 195 had suture-only repair. After the surgery, both groups demonstrated comparable improvements in symptoms. Short-term anatomic hernia recurrence rates were 11.8% and 15.6% for mesh and suture groups, respectively (p = 0.609), while longer-term rates were 24.7% and 44.9% (p = 0.015). The rates of symptomatic hernia recurrence in the same group were 8.8% and 14.6% in the short-term (p = 0.256), and 17.2% and 42.2% in longer-term follow-ups (p = 0.003). In the repair of medium and large-size hernias, mesh reinforcement resulted in a 50.0% relative risk reduction in anatomic hernia recurrences and a 59.2% reduction in symptomatic hernia recurrences at ≥ 1-year follow-up. CONCLUSION After more than a year of follow-up, it has been found that using biosynthetic mesh for medium and large hiatal or paraesophageal hernia repair significantly reduces the likelihood of both anatomic and symptomatic recurrence compared to using only suture cruroplasty. These findings strongly support the use of biosynthetic mesh to manage larger hernias. However, further long-term multicenter randomized studies are needed to provide more conclusive evidence.
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Affiliation(s)
- Niloufar Salehi
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Teagan Marshall
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Blake Christianson
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Hala Al Asadi
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Haythem Najah
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Yeon Joo Lee-Saxton
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Abhinay Tumati
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Parima Safe
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Alexander Gavlin
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Manjil Chatterji
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Brendan M Finnerty
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Thomas J Fahey
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Rasa Zarnegar
- Division of Endocrine & Minimally Invasive Surgery, Department of Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
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Azimov RK, Al-Ariki M, Akhmedov TZ, Tarxani M. [Titanium mesh implants in herniology]. Khirurgiia (Mosk) 2019:126-131. [PMID: 31825353 DOI: 10.17116/hirurgia2019121126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Literature review is devoted to the main implants used in hernia surgery and their disadvantages. Advisability of titanium mesh implants in surgery of anterior abdominal wall hernias is shown.
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Affiliation(s)
- R Kh Azimov
- The Department of hospital surgery with the course of pediatric surgery of the RUDN University, Moscow, Russia
| | - M Al-Ariki
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - T Z Akhmedov
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
| | - M Tarxani
- Central Clinical Hospital of the Russian Academy of Sciences, Moscow, Russia
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