Archive | 2021
Laparoscopic hiatal hernia repair: mesh or no mesh? A narrative review
Abstract
Laparoscopic hiatal hernia repair (LHHR) was first reported by Cuschieri et al. in 1992 (1). and even in early comparisons the laparoscopic approach carried a lower morbidity, less blood loss, and reduced ICU stay (2). In the early 2000s, however, longer-term follow-up revealed a recurrence rate of nearly 50% on routine esophagram, compared to only 15% in an open surgery cohort (3). Adding a mesh reinforcement to the suture cruroplasty was a natural response to the problem of high recurrence rates. Carlson et al. in 1997 described the first randomized control trial of mesh reinforcement in laparoscopic hiatal hernia repair, using a PTFE keyhole mesh and showing good early outcomes in a small cohort (4). Similarly, Demeester et al. also published a series, 10 years after their first description of a laparoscopic repair, adding mesh reinforcement and frequent Collis gastroplasty, resulting in a decrease in recurrence rates from 50% to 18% on routine esophagram (5). The addition of mesh to the laparoscopic hernia repair is intuitive: mesh is routinely used in inguinal and ventral hernias, and a tension-free repair is a basic surgical principle. This is even more compelling at the hiatus, where Review Article