Our Summary

This study looked at whether using a mesh during a specific type of hernia surgery (laparoscopic large hiatal hernia repair) improves patient outcomes compared to using sutures (stitches). The researchers analyzed 13 previous studies (involving 1,194 patients) that compared the two methods.

They found that most of these studies reported significant symptom improvement. However, they didn’t have enough data to compare how many patients had recurring symptoms. The timing of the follow-up evaluations also tended to be longer after suture surgery.

The odds of the hernia coming back were lower with mesh surgery, but the need for a second operation was not significantly different. The quality of the evidence supporting the routine use of mesh is low, so it should be used at the surgeon’s discretion until more studies are done. These future studies should look at symptom outcomes, quality of life, and long-term recurrence.

FAQs

  1. Does using a mesh during a laparoscopic large hiatal hernia repair improve patient outcomes compared to using sutures?
  2. Is the chance of the hernia recurring lower with mesh surgery compared to suture surgery?
  3. What should future studies on hernia repair focus on?

Doctor’s Tip

Therefore, a helpful tip a doctor might tell a patient about hiatal hernia repair is that using mesh during surgery may reduce the likelihood of the hernia coming back, but more research is needed to determine the long-term benefits and risks. It is important to discuss with your surgeon the best option for your specific case and to follow up regularly to monitor your symptoms and recovery.

Suitable For

Patients who are typically recommended for hiatal hernia repair are those with large hiatal hernias and significant symptoms such as heartburn, regurgitation, difficulty swallowing, chest pain, and reflux. Patients who have tried conservative treatments such as lifestyle changes, medications, and diet modifications without success may also be candidates for surgery. Additionally, patients who have complications of hiatal hernias such as Barrett’s esophagus or severe inflammation of the esophagus may also be recommended for surgery.

Timeline

Before hiatal hernia repair:

  • Patient may experience symptoms such as heartburn, chest pain, difficulty swallowing, and regurgitation of food or acid
  • Patient may undergo diagnostic tests such as upper endoscopy, barium swallow, or pH monitoring to confirm the presence of a hiatal hernia
  • Patient may be advised to make lifestyle changes such as avoiding certain foods, losing weight, and elevating the head of the bed to reduce symptoms

After hiatal hernia repair:

  • Patient will undergo laparoscopic surgery to repair the hernia, which may involve using sutures or a mesh to close the opening in the diaphragm
  • Patient may experience pain, bloating, and difficulty swallowing in the immediate postoperative period
  • Patient will be discharged home with instructions on diet, activity restrictions, and follow-up appointments
  • Patient will gradually resume normal activities and may experience improvements in symptoms such as reduced heartburn and regurgitation
  • Patient will be monitored for any complications or recurrence of symptoms in the weeks and months following surgery, with long-term outcomes still being studied.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hiatal hernia repair surgery?
  2. How long is the recovery process after surgery, and what can I expect in terms of pain and discomfort?
  3. Will I need to follow a special diet or make any lifestyle changes after the surgery?
  4. How long do the results of the surgery typically last, and is there a chance that the hernia could come back?
  5. What type of surgical technique do you recommend for my specific case, and why?
  6. Are there any alternative treatment options to surgery that I should consider?
  7. How many hiatal hernia repair surgeries have you performed, and what is your success rate?
  8. Will I need to undergo any additional tests or evaluations before the surgery?
  9. What is the expected outcome in terms of symptom improvement and quality of life after the surgery?
  10. Are there any specific post-operative instructions or precautions that I should be aware of?

Reference

Authors: Tam V, Winger DG, Nason KS. Journal: Am J Surg. 2016 Jan;211(1):226-38. doi: 10.1016/j.amjsurg.2015.07.007. Epub 2015 Sep 18. PMID: 26520872