Our Summary

This research paper is a review and analysis of 17 studies covering 1857 patients who went through hiatal hernia repair, a complex surgical procedure. The surgery can be done in various ways, and there is no standard way of doing it. This study compared the use of a surgical technique called cruroplasty, with the use of two types of mesh as reinforcement - one that the body can absorb (AM) and one that it can’t (NAM).

The results showed that the risk of the hernia coming back was higher in patients who had the AM mesh or just the cruroplasty compared to those who had the NAM mesh. However, the rate of complications after the surgery was similar for all groups. The occurrence of mesh erosion (where the mesh wears away) after the surgery was also low.

The authors conclude that using mesh reinforcement in the surgery significantly reduces the risk of the hernia coming back compared to just using cruroplasty. However, they also note that there isn’t enough evidence to compare the two types of mesh.

FAQs

  1. What is the main finding of this review and analysis of hiatal hernia repair studies?
  2. Is there a difference in the risk of hernia recurrence between using absorbable mesh (AM), non-absorbable mesh (NAM), and cruroplasty alone in surgery?
  3. What are the complication rates and occurrence of mesh erosion after the surgery for the different techniques?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hiatal hernia repair is to discuss with them the option of using mesh reinforcement during the surgery. This can significantly reduce the risk of the hernia coming back compared to just using cruroplasty alone. It is important to weigh the potential benefits and risks of using mesh with the patient before making a decision on the surgical approach.

Suitable For

Patients who are typically recommended for hiatal hernia repair are those who have severe symptoms such as chronic heartburn, regurgitation, chest pain, difficulty swallowing, and respiratory issues. These symptoms can significantly impact a patient’s quality of life and may not be effectively managed with medication or lifestyle changes alone. Additionally, patients with complications such as Barrett’s esophagus, ulceration, or strictures may also require surgical intervention.

It is important for patients to undergo a thorough evaluation by a healthcare provider to determine if surgery is the best course of action for their specific situation. Factors such as the size of the hernia, the severity of symptoms, and the patient’s overall health and medical history will all be taken into consideration when determining if surgery is necessary.

Ultimately, the decision to undergo hiatal hernia repair should be made in collaboration with a healthcare provider who can provide guidance and support throughout the process.

Timeline

Before hiatal hernia repair:

  1. Patient experiences symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation of food.
  2. Patient undergoes diagnostic tests such as endoscopy, barium swallow, and pH monitoring to confirm the presence of a hiatal hernia.
  3. Patient may be prescribed medications such as proton pump inhibitors to manage symptoms.

After hiatal hernia repair:

  1. Patient undergoes surgery to repair the hiatal hernia, which may involve cruroplasty or the use of mesh reinforcement.
  2. Recovery from surgery typically involves a hospital stay of 1-2 days and a few weeks of restricted activity.
  3. Patient may experience some discomfort, bloating, and difficulty swallowing in the immediate post-operative period.
  4. Follow-up appointments with the surgeon are scheduled to monitor healing and address any complications.
  5. Patient gradually resumes normal activities and experiences improvement in symptoms such as heartburn and regurgitation.

What to Ask Your Doctor

  1. What is the best surgical technique for my specific case of hiatal hernia repair?
  2. What are the benefits of using mesh reinforcement compared to just having cruroplasty?
  3. What are the potential risks and complications associated with hiatal hernia repair surgery?
  4. How long is the recovery period after the surgery, and what can I expect during the recovery process?
  5. Are there any dietary or lifestyle changes I should make before or after the surgery to improve the outcome?
  6. How often do patients experience hernia recurrence after the surgery, and what are the factors that can contribute to this?
  7. What is the long-term prognosis for patients who undergo hiatal hernia repair surgery?
  8. Are there any alternative treatment options for hiatal hernia that I should consider before opting for surgery?
  9. How experienced are you in performing hiatal hernia repair surgery, and what is your success rate with this procedure?
  10. Are there any specific follow-up appointments or tests that I should schedule after the surgery to monitor my recovery and ensure the hernia does not recur?

Reference

Authors: Rausa E, Manfredi R, Kelly ME, Bianco F, Aiolfi A, Bonitta G, Zappa MA, Lucianetti A. Journal: J Laparoendosc Adv Surg Tech A. 2021 Oct;31(10):1118-1123. doi: 10.1089/lap.2020.0752. Epub 2020 Dec 17. PMID: 33332239