Surgical and clinical outcomes comparison of mesh usage in laparoscopic hiatal hernia repair

Priscila R. Armijo, Crystal Krause, Tailong Xu, Valerie Shostrom, Dmitry Oleynikov

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Use of absorbable mesh in hiatal hernia (HH) repair has been shown to decrease recurrence rates. Our aim was to compare the efficiency of three meshes in relation to the surgical outcomes of patients undergoing HH repair. Methods: A single-institution retrospective review was done for adult patients who underwent HH repair with mesh between 2004 and 2016. Demographics, intra-operative, and cost data were collected. Esophageal symptoms and medication use were assessed pre- and postoperatively. Surgical outcomes were evaluated at 6-, 12-months, and long-term follow-up. Three groups were created based on type of mesh: human tissue matrix (HTM), biosynthetic mesh (BIOS), or porcine tissue matrix (PTM). Comparisons were performed between groups using SPSS v.26.0 and PC SAS v9.4, α = 0.05. Results: 292 patients were included (HTM:N = 162, BIOS:N = 83, PTM:N = 47). Majority were male (60.4%), Caucasian (93.2%), median age, and BMI of 59 years [25–90 years] and 29.19 kg/m2 [18.9–58.0 kg/m2], respectively. 69% had a large HH. Median follow-up time was 27 months [1–166 months]. Overall recurrence rate was 39%, being significantly lower in BIOS at long-term (HTM: 31%, BIOS: 17%, PTM: 19%, p = 0.038). All groups had a significant postoperative improvement of esophageal symptoms, all p < 0.001. 65–70% of the cost difference between the groups was incurred by the cost of mesh alone (HTM: $1072, BIOS: $548, PTM: $1295), with the remainder attributable to the surgery itself. Conclusion: While outcomes of the three mesh groups were similar in our data, there was a significant difference in mesh cost. Surgeon and hospital preference still play a role in choosing the type of mesh used; however, knowledge of the individual mesh cost will help surgeons make better informed decisions.

Original languageEnglish (US)
Pages (from-to)2724-2730
Number of pages7
JournalSurgical endoscopy
Volume35
Issue number6
DOIs
StatePublished - Jun 2021

Keywords

  • Cost
  • Hiatal hernia repair
  • Mesh
  • Outcomes
  • Paraesophageal hernia

ASJC Scopus subject areas

  • Surgery

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