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Title: Five Year Follow-up of a Randomized Controlled Trial of Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Versus Nonabsorbable Mesh.
Austin Authors: Watson, David I;Thompson, Sarah K;Devitt, Peter G;Aly, Ahmad ;Irvine, Tanya;Woods, Simon D;Gan, Susan;Game, Philip A;Jamieson, Glyn G
Affiliation: University of Melbourne Department of Surgery, Austin Hospital, Heidelberg, Victoria, Australia
Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
Cabrini Hospital, Malvern, Victoria, Australia
Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia
Issue Date: Aug-2020 2019-12-05
Publication information: Annals of Surgery 2020; 272(2): 241-247
Abstract: To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair. Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair. Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years. 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh. No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.
Description: Duplicated in PubMed: PMID for Pre-print is 31804398
DOI: 10.1097/SLA.0000000000003734
Journal: Annals of Surgery
PubMed URL: 32675536
Type: Journal Article
Appears in Collections:Journal articles

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