Our Summary
This research paper looks at the use of biosynthetic mesh in hiatal hernia repair surgery. Hiatal hernia is a condition where part of the stomach pushes up into the chest through an opening in the diaphragm. Using a mesh to strengthen the area of the repair can help reduce the risk of the hernia recurring, but the use of such meshes is a controversial topic.
The researchers carried out a systematic review of existing studies on the topic, following specific guidelines to ensure the review was thorough and unbiased. They found 18 relevant studies, covering a total of 1,846 patients. The studies they reviewed used three different types of biosynthetic mesh in the surgeries.
The researchers found that the average length of the surgeries varied from around two to almost four hours. The patients were followed up for periods ranging from a year to over four years after their surgeries. None of the studies reported any issues with the mesh eroding or needing to be removed. There was one case where the mesh caused a narrowing that required further surgery.
The studies showed that the patients’ symptoms improved after surgery and their quality of life scores increased. They were generally happy with the results of their surgery. However, the rate of recurrence of the hernia varied widely across the studies, from less than 1% to 25%.
The researchers concluded that using biosynthetic mesh in hiatal hernia repair is safe and effective. It has low complication rates, and symptoms improve after surgery. However, they noted that the rate of recurrence varied quite a bit across the studies, likely due to differences in how recurrence was defined and measured. They recommended more randomized controlled trials with larger numbers of patients and longer follow-up periods to get a better idea of the success rate of this procedure.
FAQs
- What is a hiatal hernia and how is it repaired with biosynthetic mesh?
- What were the findings of the researchers regarding the use of biosynthetic mesh in hiatal hernia repair?
- Why is the rate of recurrence for hiatal hernia after surgery with biosynthetic mesh varying across studies?
Doctor’s Tip
A helpful tip a doctor might tell a patient about hiatal hernia repair using biosynthetic mesh is to follow post-operative instructions carefully to ensure proper healing and reduce the risk of complications. This may include avoiding heavy lifting, following a specific diet, taking prescribed medications, and attending follow-up appointments with the surgeon for monitoring. It is also important to report any new or worsening symptoms to the doctor promptly.
Suitable For
Patients who are typically recommended for hiatal hernia repair surgery are those who have symptoms such as reflux, heartburn, difficulty swallowing, chest pain, or regurgitation that are not adequately controlled with medications. In addition, patients with complications of hiatal hernia such as Barrett’s esophagus, esophageal stricture, or recurrent pneumonia may also be candidates for surgery. Patients who have a large hiatal hernia that is causing significant symptoms or complications may also benefit from surgical repair. Ultimately, the decision to undergo surgery should be made in consultation with a surgeon after a thorough evaluation of the patient’s symptoms and medical history.
Timeline
Before surgery: Patients with a hiatal hernia may experience symptoms such as heartburn, regurgitation, chest pain, difficulty swallowing, and feeling full quickly. They may undergo diagnostic tests such as endoscopy and imaging studies to confirm the diagnosis. Treatment options may include medications to reduce stomach acid, lifestyle changes, and dietary modifications.
Day of surgery: Patients undergo hiatal hernia repair surgery, which may involve using biosynthetic mesh to strengthen the repair site. The surgery typically lasts around two to four hours.
After surgery: Patients are monitored in the recovery room before being transferred to a hospital room. They may experience some pain, discomfort, and bloating in the days following surgery. Patients are usually discharged from the hospital within a few days and are advised to follow a specific diet and activity restrictions during the initial recovery period.
Follow-up appointments: Patients have follow-up appointments with their healthcare provider to monitor their recovery and address any concerns or complications. Over the following weeks and months, patients gradually resume their normal activities and may experience improvements in their symptoms.
Long-term outcomes: Studies have shown that using biosynthetic mesh in hiatal hernia repair surgery can lead to improvements in symptoms and quality of life for patients. However, the rate of hernia recurrence varies among studies, highlighting the need for further research to determine the long-term success of this procedure.
What to Ask Your Doctor
Some questions a patient should ask their doctor about hiatal hernia repair using biosynthetic mesh include:
- What are the potential risks and complications associated with using biosynthetic mesh in hiatal hernia repair surgery?
- How long does the surgery typically take, and what is the expected recovery time?
- What is the success rate of hiatal hernia repair using biosynthetic mesh in terms of preventing recurrence?
- How will the biosynthetic mesh be placed during the surgery, and will it need to be removed in the future?
- What is the expected improvement in symptoms and quality of life after the surgery?
- Are there any specific lifestyle changes or post-operative care instructions I should follow to ensure the best outcome?
- How often will I need follow-up appointments after the surgery, and what will be monitored during these appointments?
- Are there any alternative treatment options to consider, and why is using biosynthetic mesh recommended in my case?
- Will I need any additional tests or imaging studies before the surgery to determine the extent of the hernia and plan the repair?
- Can you provide me with information about the specific type of biosynthetic mesh that will be used in my surgery and any potential side effects associated with it?
Reference
Authors: Lima DL, de Figueiredo SMP, Pereira X, Murillo FR, Sreeramoju P, Malcher F, Damani T. Journal: Surg Endosc. 2023 Oct;37(10):7425-7436. doi: 10.1007/s00464-023-10379-1. Epub 2023 Sep 18. PMID: 37721592