腹腔镜胃底折叠术治疗胃食管反流病372例

目的 探讨腹腔镜胃底折叠术治疗胃食管反流病(GERD)的可行性和临床应用价值.方法 2005年9月至2010年8月,对372例GERD病人实施腹腔镜胃底折叠术,其中Nissen胃底折叠术146例,Toupet胃底折叠术79例,前180°胃底折叠术147例,记录围手术期相关指标,随访观察治疗效果.结果 372例均完成腹腔镜手术,无中转开腹者.手术时间50～210 min,平均85 min;术中出血40～150 ml,平均86 ml.术后住院3～21天,平均4.3天.术后临床症状均得到缓解,无严重并发症及死亡病例.术后3个月复查胃镜、上消化道造影、食管测压和24 h食管pH检测均恢复正常.350例随访～63个月,平均27.3个月,对手术效果满意率92.57%,19例有进固体食物时轻度梗噎感,6例反酸症状复发,使用抑酸药物可控制,1例食管裂孔疝复发.结论 腹腔镜胃底折叠术治疗中、重度GERD充分体现了微创手术创伤小、恢复快、安全可行、疗效可靠的特点;3种胃底折叠方式根据病人具体情况应用,能够最大限度地保证手术效果、降低操作难度,减少术后并发症.

Abstract：

Objective To investigate the feasibility and clinical value of laparoscopic surgery in treating patients with gastroesophageal reflux disease. Methods From September 2001 to August 2009, 372 patients with gastroesophageal reflux disease undertwent laparoscopic fundoplication, including 146 cases of Nissen fundoplication, 79 Toupet fundoplication, and 147 anterior 180 degrees partial fundoplication. Para-operative clinical parameters were recorded. All patients were routinely followed up. Clinical outcomes were collected and analyzed. Results Laparoscopic surgery was successfully performed in all patients, and no conversions were required. The operating time was 50 -210 minutes (mean, 85 minutes), the operative blood loss was 40 - 150 ml( mean, 86 ml) ,the postoperative hospital stay was 3 - 21 days( mean, 4.3 days ). The symptoms in most cases were adequately relieved after operation. There were no severe postoperative morbidity and mortality. Endoscopy, radiology, esophageal manometry and 24-hour pH monitoring were repeated 3 months after surgery. After the follow-up period of 3 -63 months ( mean, 27.3 months), the satisfaction rate of operation was 92.57%. 19 cases had mild dysphagia when eating solid food. Symptoms recurrence of acid reflux occurred in 6 cases, which were controlled by antacid medications. Hiatal hernia recurrence occurred in 1 case. Conclusions Laparoscopic operation should be the method of choice to treat the moderate to severe gastroesophageal reflux disease, with the advantages of minimized trauma,quick recovery, safety,feasibility and reliable effect. According to individual condition of patients, appropriate fundoplication procedure should be employed carefully to ensure results of operations, reduce operating difficulties and the rate of postoperative complications.     

Intrathoracic major duodenal papilla with transhiatal herniation of the pancreas and duodenum:A case report and review of the literature

Transhiatal herniation of the pancreas is an extremely rare condition.In the published literature we found only eleven cases reported in the period of 1958 to 2011.A coincidental hiatal herniation of the duodenum is described in two cases only.To our knowledge,we report the first case with a hiatal herniation of the complete duodenum and proximal pancreas presenting an intrathoracic major duodenal papilla with consecutive intrahepatic and extrahepatic cholestasis.A 72-yearold Caucasian woman was admitted to our department with a hiatal hernia grade Ⅳ for further evaluation.According to our recommendation of surgical hernia repair soon after the diagnosis of a transhiatal herniation of the proximal pancreas and entire duodenum,we had to respect the declared intention of the patient for a conservative procedure.So we were forced to wait for surgical repair within an emergency situation complicated by a myocardial infarction and reduced general condition.We discuss the therapeutic decision making process and a complete literature review of this rare entity.     

后腹腔镜技术治疗肾上腺肿瘤53例报告

Objectives To summarize the clinical experience of retroperitoneal laparoscopic adrenalectomy for adrenal tumor and facilitate the clinical application.Methods From June 2002 to October 2009,S3 caws of adrenal tumor were treated with retroperitoneal laparoscopic adrenalectomy,including 19 cases of primary aldosteronism,8 cases of Cushings syndrome,9 cases of pheochromocytoma,14 cases of nonfunctional adrenal adenoma,2 cases of adrenal cyst,1 case of adrenal paraganglioma.B ultrasound and CT/MRI were used to diagnose all patients.33 tumors were on the left side and 20 on the right.The size of the tumors ranged from 1.2 to 7.0cm(mean,2.2cm).Results 49 surgeries were successfully completed.4 surgeries converted to open surgeries.The mean of operating time was 92(56～220) min.The mean of estimated blood loss was 55 (20～300 ) ml.The mean of postoperative hospitalization was 7(4～12) days.There was no serious complication during perioperative period.Conclusions Retroperitoneal laparoscopic adrenalectomy for adrenal tumor is safe and effective with the advantages of minimal invasion,quick recovery and few complications.It should be considered as the first choice for treating benign adrenal diseases.     

腹腔镜辅助下小切口巨大腹壁疝修补术

Objective To sum up the experience of performing a laparoscope-assisted hemiorrhaphy for huge ventral hernia through small incision.Methods Clinical data were retrospectively analyzed for 18 cases of huge ventral hernia admitted from Jan 2009 to Sept 2009 undergoing laparoscope- assisted hernia mpair through small incision.Data renewed including the operational duration,missed hernia,length of the incision,serumal cyst,the length of hospital stay,chronic pain and the recidivation.Results Surgery was successful in all of the 18 cases,the operational time was(129±19) main,the length of the incision was(5.6±1.0) cm.Missed hemia were identified in 3 cases during the operation.One case:suffered from postoperative serumal cyst,the postoperative length of hospital stay was(5.1±1.2) days,postoperative incisional pain lasting for more than 3 months was identified in 1 case,there was no incisional infection and nor injury to intraabdominal organs,there was no operative mortahty,all the cases were followed-up for(8.6 ±1.6)months and there was no recidivation.Conclusions The laparoscope hemia repair with the subsidiary of micro-incision is effective and safe,and it reshapes the abdominal wall.     

腹腔镜辅助下小切口巨大腹壁疝修补术

Objective To sum up the experience of performing a laparoscope-assisted hemiorrhaphy for huge ventral hernia through small incision.Methods Clinical data were retrospectively analyzed for 18 cases of huge ventral hernia admitted from Jan 2009 to Sept 2009 undergoing laparoscope- assisted hernia mpair through small incision.Data renewed including the operational duration,missed hernia,length of the incision,serumal cyst,the length of hospital stay,chronic pain and the recidivation.Results Surgery was successful in all of the 18 cases,the operational time was(129±19) main,the length of the incision was(5.6±1.0) cm.Missed hemia were identified in 3 cases during the operation.One case:suffered from postoperative serumal cyst,the postoperative length of hospital stay was(5.1±1.2) days,postoperative incisional pain lasting for more than 3 months was identified in 1 case,there was no incisional infection and nor injury to intraabdominal organs,there was no operative mortahty,all the cases were followed-up for(8.6 ±1.6)months and there was no recidivation.Conclusions The laparoscope hemia repair with the subsidiary of micro-incision is effective and safe,and it reshapes the abdominal wall.     

后腹腔镜技术治疗肾上腺肿瘤53例报告

Objectives To summarize the clinical experience of retroperitoneal laparoscopic adrenalectomy for adrenal tumor and facilitate the clinical application.Methods From June 2002 to October 2009,S3 caws of adrenal tumor were treated with retroperitoneal laparoscopic adrenalectomy,including 19 cases of primary aldosteronism,8 cases of Cushings syndrome,9 cases of pheochromocytoma,14 cases of nonfunctional adrenal adenoma,2 cases of adrenal cyst,1 case of adrenal paraganglioma.B ultrasound and CT/MRI were used to diagnose all patients.33 tumors were on the left side and 20 on the right.The size of the tumors ranged from 1.2 to 7.0cm(mean,2.2cm).Results 49 surgeries were successfully completed.4 surgeries converted to open surgeries.The mean of operating time was 92(56～220) min.The mean of estimated blood loss was 55 (20～300 ) ml.The mean of postoperative hospitalization was 7(4～12) days.There was no serious complication during perioperative period.Conclusions Retroperitoneal laparoscopic adrenalectomy for adrenal tumor is safe and effective with the advantages of minimal invasion,quick recovery and few complications.It should be considered as the first choice for treating benign adrenal diseases.     

后腹腔镜下冷冻消融治疗小肾肿瘤的初步报告

Objective To present the technique and short-term results of retroperitoneal laparoscopic renal cryoablation for small renal tumors. Methods Ten selected patients cases with 11 renal tumors were included in present study. There were 3 cases of left renal tumor, 6 cases of right renal tumor and 1 case of bilateral renal tumors. Tumors were located at the upper pole (2), middle (6), or lower pole (3). All tumors were located distant from the collecting system, without evidence of metastatic disease. Mean tumor size was 2. 8 cm (range: 1.5-4.0). All the patients were managed with a double freeze-thaw cycle of retroperitoneal laparoscopic renal cryoablation. The preoperative Hb was (137± 21)g/L, ESR was (27±12)mm/1 h, SCr was (92±41)μmol/L, GFR was (42±10)ml/min.All the patients were taken routine biopsies. Results Cryoablation was technically successful in all 10 patients (11 tumors). The mean time of the operations was (101 ± 31) min, and the mean blood loss was (42±21) ml. None of the cases received blood transfusion post-operation. No operative complication was seen. The postoperative hospital stay was (4±2) d. The postoperative Hb was (129 ±18)g/L,ESR was (31±14)mm/1 h,SCr was (95±39)μmol/L,GFR was (40±11)ml/min. There was no statistic change of Hb, ESR, SCr and ECT-GFR after operations(P＞0. 05). The biopsy results revealed that 8 tumors were renal clear cell carcinomas, and 2 tumors were papillary renal cell carcinomas, and 1 tumor was renal angiomyolipoma. All the patients had a minimum follow-up of 6 months (mean 16, range 6 to 21). Follow-up magnetic resonance imaging at 1, 3, and 6 months identified the punched-out, nonenhancing, spontaneously resorbing, renal cryolesions. Follow-up biopsie of the cryoablated tumor site was negative in the only patient who have undergone the biopsy. No evidence of local or port-site recurrence was found, and no metastatic disease. Conclusions Retroperitoneal laparoscopic renal cryoablation for small renal tumors could be an accurate and effective intervention with a relatively low incidence of complications. Critical long-term data regarding laparoscopic renal cryoablation are awaited.     

轻质量型网片在老年腹股沟疝无张力疝修补术中的应用

目的 总结轻质量型网片在老年腹股沟疝无张力疝修补术中的临床应用疗效.方法 对120例(128侧)60岁以上老年腹股沟疝患者用轻质量型网片进行无张力疝修补术,观察术后早期并发症的情况、术后下床活动时间、住院天数、术后慢性疼痛、异物不适感的发生率和术后复发情况.结果 全组均顺利实施手术,其中,实施薇普Ⅱ平片疝修补术72例(77侧),实施超普平片疝修补术10例(11侧),实施超普网塞平片疝修补术6例,实施超普疝修补装置疝修补术32例(34侧).平均手术时间(43±12)min;术后早期发生阴囊浆液肿9例,尿潴留5例,切口血肿4例;平均术后下床活动时间(17.4±1.8)h,平均住院天数(7.4±1.9)d.术后6个月仅发生轻度慢性疼痛2例(VAS级评分＜2),发生率为1.7%(2/120);异物不适感11例,发生率为9.1%(11/120).随访6～48个月,平均随访(25±13)个月,无一例复发.结论 用轻质量型网片进行老年腹股沟疝无张力疝修补术是安全、可靠的,术后慢性疼痛和异物不适感发生率较低.

Abstract：

Objective To evaluate low-weight mesh for tension-free repair of inguinal hernia in the elders. Methods 120 old patients ( age at 60 -97 years) underwent tension-free repair of inguinal hernia by using low-weight mesh. The early complications, time of up and about, hospital stay, postoperative chronic pain,foreign body feelings and hernia recurrence were analyzed. Results The operations were successful in all cases and the average time of operation was (43 ± 12 ) min. 9 cases suffered from edema of the scrotum, 5 cases suffered urine retention, 4 cases suffered from incision hematoma. The average time of outof-bed was ( 17.4 ± 1.8 ) h, the average hospital days was ( 7.4 ± 1.9) d. However, there were 1.7%(2/120) patients suffering from slight chronic pain and 9. 1% (11/120) patients complaining foreign body feelings. There was no recurrence after follow-up for 6 to 48 months. Conclusions The clinical application of low-weight mesh for tension-free repair of inguinal hernia in old age is safe and effective, with an additional advantage of low occurrence of chronic pain and foreign body feelings.     

Posterolateral dislocation of the knee joints：analysis of 9 case

Objective:To analyze the rtraumatie pathologieal characteristics of posterolateral dislocation of knee joins and its treatment.Methods:Mine cases of posterolateral dislocation of knee joint,5 cases of fresh injuries(the fresh injury group)and 4 cases of old injuries (the old injury group)were reviewed and analyzed.In the fresh injury group 4 cases failed in close reduction due to “buttonholing”through the medial joint,among them 3 case underwent repair of the damaged ligantents.In the old injury group 2 cases underwant ACL and MCL repair only in acuts stage,but re-dislocated.Of the rest 2 case 1 was associated with peroneal nerve injury and the other was not treated of the tibiul condyle and popllteal artery injury.Open reduction was performed in 3 enses.One case was fixed with 2-crossed pin and another was fixed with one pin through the tibial and femoral condyle and second pin with olecranization fixation.Plester immobilization for 6.8 weeks respectively was required.In the old injury group in 1 case ACL and PCL repair(Augustine method) and posterolateral structure were performed and olecranization fixation and plaster immobilization for 6 weeks was needed.Arthrodesis of the knee was done for the patient with comminuted fracture of the tibial condyte and popliteal artery injury.Results:All the cases were followed up for 1-23 years(average 6 years).Knee stabllity in 4 cases with repair of the ligaments was improved,although PDT showed ( ) with different was improved,although the patients treated with ligamentous reconstruction were much better than those of the patients without any repair. Conclusions:Well understanding of the tranmatic pathological characteristics,repair of the damaged postoperative immobilization for 6 weeks are the key points of successful treatment.     

腹腔镜下扩大性膀胱部分切除联合盆腔淋巴结清扫术治疗脐尿管癌

Objective To discuss the techniques and clinical efficacy of laparoscopic partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma. Methods From July 2006 to April 2008, 4 patients with urachal adenocarcinoma were managed by the laparoscopic procedure. Three patients were male, the other one was female, with a median age of 51 (range 42 to 66)years. The mean size of tumors was 3.4(rang 1.9 to 5.4)cm in diameter. Three of them were diagnosed as mucinous adenocarcinoma, the other one was adenocarcinoma. There was 1 patient at stage Ⅱ , and the other three as stage Ⅲ according to Sheldon Stage. Four patients were performed by transperitoneal approach. The boundaries of resection were similar to the open surgery, including resection of the tumor with normal margins, the peritoneum lateral to the two medial unbilical ligaments,the posterior sheath of the rectus muscle and the muscle fibers of the rectus muscle below it, and bilateral pelvic lymphanodes. Results The procedure was successfully in all 4 patients, with a mean operative time of 220(range 150 to 350)min, a mean estimated blood loss of 180 (range 120 to 290)ml.No significant intraoperative or postoperative complications occurred, except for an inferior epigastric artery injury in 1 case. The mean postoperative in-dwelling urinary catheter time was 6 (range 5 to 7)d, and the mean postoperative hospital stay was 6 (range 5 to 8)d. All 36 resected lymph nodes (range 8 to 11) were negative. At a median follow-up of 25(range 15 to 36) months, there was no evidence of recurrent disease by radiologic or cystoscopic evaluation. Conclusion Laparoscopic partial cystectomy and bilateral extended pelvic lymphadenectomy in selected patients with urachal tumors could be a safe, feasible, minimally invasive procedure.     

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??Laparoscopic repair of giant esophageal hiatal hernia MA Bing,TIAN Wen, CHEN Lin??et al. Department of General Surgery, PLA General Hospital , Beijing 100853 ,China
Corresponding author: TIAN Wen,E-mail: tianwen301@sina.com
Abstract Objective To investigate the reliability and effectivity of laparoscopic repair of esophageal hiatal hernia using mesh combined with Toupet partial fundoplication. Methods From August 2006 to April 2009, 13 patients with esophageal hiatal hernia were treated by laparoscopic repair using mesh combined with Toupet partial fundoplication at PLA General Hospital. Results Twelve patients were completed under laparoscope successfully. One patient converted to open surgery. The operation time was 110 min (90-180 min) and the blood loss volume was 50 mL (30-120 mL). Symptoms of 12 patients were relieved completely. The mean postoperative hospital stay was 6 day (3-30d). The patients were followed up for 3-25 months (mean 12 months). No case was found recurrence of hernia. Conclusion Laparoscopic mesh repair is safe and effective for giant esophageal hiatal hernia with few side effect.     

Composite mesh repair of a large paraesophageal hiatal hernia

We describe the first experience in Italy with a new pre-cut composite polytetrafluoroethylene (PTFE)/expanded PTFE (ePTFE) prosthesis designed for the hiatal region. A 78-year-old female patient with a large paraesophageal hiatal hernia with migration of the left transverse colon inside the hiatal defect (type IV hernia) received laparoscopic repair by means of the composite V-shaped mesh. The procedure was completed laparoscopically and a partial fundoplication was performed. A favorable outcome was assessed by barium swallow radiograms performed on postoperative day 7. A complete resolution of the symptoms was noted at follow-up 1 month postoperatively. This report confirms the feasibility, effectiveness, and added advantages of the composite V-shaped mesh in tension-free repair of a large hiatal hernia.     

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??Laparoscopic repair for giant hiatal hernia??A clinical analysis of 75 patients SUN Xiang-yu, QIN Ming-fang, ZHAO Hong-zhi, et al. Department of Mini-invasive Surgery, Tianjin Nankai Hospital, Tianjin 300100, China
Corresponding author: SUN Xiang-yu, E-mail: xiangyusun79@126.com
Abstract Objective To investigate the safety and effectiveness of laparoscopic repair for giant hiatal hernia. Methods The clinical data of 75 patients with giant hiatal hernia performed laparoscopic repair between January 2006 and August 2012 in Tianjin Nankai Hospital were analyzed retrospectively. The operation time, hospitalization time, intraoperative and postoperative complications, postoperative improvement of symptoms and upper gastrointestinal imaging were studied. Results All the patients were treated by laparoscopy successfully. Fifty-one patients were reinforced with meshes. Twenty-four patients were reinforced without mesh. Hiatal pillars in 40 patients were partly contracted and closed with meshes. Hiatal pillars in 35 patients were directly closed up to normal diameter by interrupted stitches. Among them, 11 patients were placed with meshes. Laparoscopic repair complicated with fundoplication was performed in 64 patients with average operation time of (97.2±2.1)min, average operative blood loss of (82.0±1.7)mL and average hospital stay of (5.0±1.2)d. No conversion and death occurred. Seventeen patients (22.7%) had short-term or long-term complications. Seventy-five patients were followed up for 3 months to 62 months with average of (31.0±2.1)months. Main symptoms of 66 patients (88%) were disappeared. Nine patients ??12%??had recurrence of symptoms. Four patients??5.3%??were found recurrence by barium swallow. Conclusion Laparoscopic repair for giant hiatal hernia is safe and reliable. Mesh repair can reduce the recurrence rate but accompanied with risk of complication.     

腹腔镜食管裂孔疝修补术的临床分析

目的：总结腹腔镜下应用补片行食管裂孔疝修补和部分胃底折叠术治疗食管裂孔疝的初步经验。方法：2007年5月至2009年12月为13例食管裂孔疝患者行腹腔镜食管裂孔疝修补术或（和）胃底折叠术。观察术后相关并发症。结果：13例手术均获成功,无中转开放手术。手术时间130-205min,平均152min,术中基本无出血。术后第2天开始饮水,第3天开始进流质饮食。术后住院4-6d。1例直接缝合者术日晚发生气胸,经胸腔穿刺抽气消失。1例胃底折叠术患者在开始进普通饮食时有轻微吞咽困难,术后1个月临床症状消失。术后随访6-12个月,平均8.5个月,行钡餐造影或CT检查均未见复发。结论：腹腔镜下应用补片和（或）胃底折叠术治疗食管裂孔疝安全有效,值得临床推广。     

Polyester composite mesh for laparoscopic paraesophageal hernia repair

Recent evidence supports the use of prosthetic reinforcement material during laparoscopic hiatal hernia repair; however, the search for appropriate prosthetic materials is still under investigation. In this article, the technical feasibility and the short-term outcomes of the use of polyester composite mesh for crural reinforcement was determined. A small series of patients with large paraesophageal hiatal hernias underwent laparoscopic repair with mesh (5 males; mean age = 62 +/- 10 years; mean body mass index = 29 +/- 1 kg/m2, and mean American Society of Anesthesiologists = 3 +/- .4). There were no postoperative complications, deaths, or evidence of hernia recurrence documented by barium study at a median follow-up of 9 months. The use of the polyester composite mesh is technically feasible, has excellent intracorporeal handling characteristics, and holds suture readily. The short-term outcomes of the use of the polyester composite mesh for paraesophageal hernia repair reinforcement appeared to be favorable and are encouraging.     

Tension-free repair of hiatal hernia during laparoscopic fundoplication: a ten-year experience

Background: The breakdown of a hiatal hernia repair can lead to clinical failure. The use of prosthetic material at the esophageal hiatus to strengthen the crural repair is relatively new and questions remain. This report examines the safety and efficacy of a tension-free crural repair with mesh.Patients and methods: Since 1993, 135 consecutive patients (19–86) [9 re-do] completed laparoscopic tension-free hiatal hernia repair prior to Nissen wrap. Esophageal hiatus was patched with a PTFE mesh (first 112 patients) or a PTFE/ePTFE composite (23 patients) secured across the defect with staples to each crura. 130 patients completed a phone questionnaire during 2003/2004 (mean f/u 64 months).Results: There have been no short-term nor long-term infections related to the PTFE mesh. Symptoms were resolved or improved and resolved with meds in 122/130 (94%). Early re-herniation occurred in one patient after vigorous exercise.Conclusions: Mesh repair/patch of the esophageal hiatus can be done without infection, with results similar to standard crural repair and consistent with surgical principles of non-tension.     

腹腔镜食管裂孔疝修补术8例报告

目的:总结腹腔镜手术治疗食管裂孔疝的经验。方法:回顾分析2004年5月至2009年3月我院采用腹腔镜手术治疗8例食管裂孔疝患者的临床资料,其中食管旁疝(Ⅱ型)3例,混合型疝(Ⅲ型)5例,伴有轻度胃食管返流2例,中度或重度6例。行食管裂孔修补+Toupet胃底折叠术4例,食管裂孔修补+Nissen 360°胃底折叠术4例,其中2例行专用补片修补术。结果:8例患者均顺利完成手术,无中转开腹或开胸手术。手术时间2.2～6.5h,平均3.2h,术后1例发生一过性皮下气肿,2例出现暂时性吞咽困难,均经保守治疗缓解,全组患者原有症状均明显好转或完全消失。术后住院4～16d,平均10d,随访10～26个月,平均18个月,无复发。结论:腹腔镜手术治疗食管裂孔疝具有患者创伤小、康复快等特点,临床效果满意,值得推广。     

腹腔镜下造口旁疝补片修补术应用体会

目的探讨腹腔镜下造口旁疝修补术的临床效果。方法回顾性分析2007年9月至2010年4月期间8例行腹腔镜下造瘘口旁疝补片修补术患者的临床资料,分析手术情况、术后并发症及复发情况。结果 8例造口旁疝患者均在腹腔镜下修补成功。手术时间50～180min,平均135min。疝环大小4.5～6.5cm,平均5.0cm。术后1例出现肠梗阻及复发,后行腹腔镜探查及再次修补术。2例术后早期出现腹胀,1周后腹胀缓解。1例术后出现术区疼痛不适,对症治疗后缓解。本组未发生术区感染。住院时间5～14d,平均7.6d。术后随访1年,除1例复发后行再次手术外,均未见复发。结论腹腔镜下造口旁疝修补术如果注意操作要点,可以替代传统修补术。     

Mesh in laparoscopic large hiatal hernia repair: a systematic review of the literature

Background

The use of mesh is becoming more popular for large hiatal hernia (type II–IV) repair to reduce the recurrence rate. The aim of this study was to outline the currently available literature on the use of mesh in laparoscopic large hiatal hernia repair, emphasizing objective outcome.

Methods

A structured search of the literature was performed in the Medline, Embase, and Cochrane Central Register of Controlled Trials databases.

Results

A total of 26 studies met the inclusion criteria. There were three randomized controlled trials, seven prospective and five retrospective cohort studies, and five prospective and one retrospective case–control study. The study design was not reported in the remaining studies. In the included studies, laparoscopic hiatal hernia repair was performed with mesh in 924 patients (mesh group) and without mesh in 340 patients (nonmesh group). The type of mesh used was very different: polypropylene in six, biomesh in nine, polytetrafluoroethylene (PTFE) in two, expanded PTFE (ePTFE) in two, and composite polypropylene–PTFE in another two. At least two different kinds of mesh were used in five studies. Radiological and/or endoscopic follow-up was performed after a mean (±SEM) period of 25.2 ± 4.0 months. There was no or only a small recurrence (recurrent hiatal hernia <2 cm) in 385 of the 451 available patients (85.4 %) in the mesh group and in 182 of 247 (73.7 %) in the nonmesh group.

Conclusions

The use of mesh in the repair of large hiatal hernias is promising with respect to the reduction of anatomical recurrences. However, many different kinds and configurations of mesh are available. This systematic review of the literature is a basis for high-quality randomized controlled trials to obtain the most effective and safe mesh in the long term.