Laparoscopic management of recurrent symptomatic hiatal hernia with and without mesh repair: a comparative prospective study

Background
Recurrence after primary hiatal hernia repair is common and ranges between 15 and 60%. Symptomatic patients who are actually in need of redosurgery are ∼5%. Resurgery after the primary repair is usually not easy and is challenging. The reputation of mesh migration and erosion into gastroesophageal junction makes most of the surgeons avoid the use of mesh in hiatal hernia repair.
Aim
This prospective study aims to compare the efficacy of redolaparoscopic Nissen fundoplication with and without mesh repair for treatment of recurrent hiatus hernia after failed primary repair, regarding improvement of recurrent symptoms, rate of recurrence of hernia after secondary repair, and postoperative patients’ satisfaction.
Patients and methods
This prospective randomized study was conducted on 25 patients who underwent redolaparoscopic Nissen fundoplication for the treatment of recurrent hiatus hernia after a failed primary repair between January 2017 and January 2020 with at least 1-year follow-up at Ain Shams University Hospitals. A total of 12 patients underwent redolaparoscopic Nissen fundoplication (group A), whereas 13 patients underwent the same technique with mesh reinforcement (group B). The outcomes of both techniques were compared regarding the postoperative improvement of recurrent symptoms, postoperative recurrence, and postoperative patients’ satisfaction.
Results
Significant differences in postoperative reflux-associated symptoms were observed in both groups than preoperatively, but with a significant higher score for dysphagia noticed in group B than group A. Anatomical recurrence occurred in three (25%) patients in group A after 12 months with relatively higher regurgitation, heartburn scores, and pH monitoring. Overall, 83.3% of patients in group A and 92.3% in group B were satisfied with their postoperative improved symptoms.
Conclusion
Mesh reinforcement is associated with less recurrence rate in comparison with redolaparoscopic Nissen fundoplication alone during short-term follow-up, but it is associated with higher incidence of postoperative dysphagia. However, some patients had recurrence after redolaparoscopic Nissen fundoplication without mesh, but their postoperative symptoms were much less compared with the preoperative ones.