Does Mesh Impact Overall Recurrence Outcomes and Does Mesh Type matter: The Ideal Reinforcement for the Paraesophageal Hernia Repair

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

Surgical Endoscopy

Abstract

Background: The benefits of mesh in paraesophageal hernia repairs after six months remains a controversial topic. With multiples types of meshes on the market there is sparce literature demonstrating the ideal product for the hiatus. Lastly, there is a paucity of data on which patient factors should be optimized to reduce recurrences. This study is a retrospective review of a high-volume foregut center comparing primary cruroplasty with and without mesh reinforcement and identifying which mesh and patient demographics contribute to recurrence.

Methods: We performed a retrospective review of all paraesophageal (type 2–4) hernia repairs performed between November 2017 and January 2021. Operative details, complications, symptoms and follow-up imaging were recorded up to September 2024. Recurrence was determined by those requiring reoperation, symptomatic sliding hiatal hernias, or those with a paraesophageal component. The primary outcome was recurrence rates between cruroplasty vs. cruroplasty with mesh reinforcement. Secondary outcomes included the impact of patient factors, comorbidities, and absorbable mesh type (Phasix ST, BIO A, Miromesh) on recurrence rates.

Results: A total of 424 paraesophageal hernia repairs were performed with 151 patients undergoing mesh reinforcement. A binomial logistic regression was used to compare primary cruroplasty vs. mesh reinforcement on recurrence outcomes. Patient factors including BMI, smoking status, age, history of previous repair, COPD, and diabetes were used as control variables. Mesh use (18%) compared with no mesh (23%) resulted in a significant decrease in recurrence rates (p = 0.048) although the model only accounted for 5.2% of variance. For all hiatal hernia repairs, previous repair was the only significant variable contributing to recurrence (p = 0.003). In those patients that had mesh repair, smoking status was the only factor associated with increased recurrence (p = 0.019). There was no significant difference in recurrence rates when comparing mesh type though Phasix ST (9.38%) and Miromesh (7.69%) did have a trend toward decreased failure rate when matched with BIO A (23.56%) reinforcement (p = 0.072). Mean follow up was 5.28 years. Conclusion: Our study suggests that mesh reinforcement may decrease recurrence rates long term. Compared with ventral hernia repair literature, other patient factors such as BMI and diabetes may not have the same deleterious impact on recurrence or repair failure rate, however smoking does increase recurrence rates in those undergoing mesh repair. This study only suggests a trend towards significance when comparing mesh types and future data collection with larger cohorts may provide better insight into the ideal mesh reinforcement.

Volume

39

Issue

Suppl 1

First Page

S11

Last Page

S12

Comments

SAGES Annual Meeting, March 12–15, 2025, Long Beach, CA

DOI

10.1007/s00464-025-11688-3

ISSN

1432-2218

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