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Cruroplasty with or without mesh? A systematic literature review with a novel time-organized proportion meta-analysis

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Abstract

Background

Improved outcomes with the use of non-absorbable mesh (NAM) for inguinal hernia repairs led to its rapid adoption for hiatal hernia (HH) repairs; however, feared complications occurred, and the trend shifted toward using absorbable mesh (AM). We aimed to analyze the literature assessing objective HH recurrence rates after primary laparoscopic cruroplasty with or without the use of different mesh types.

Methods

A systematic literature review with both pairwise and time-organized proportion meta-analyses of articles published between January 1993 and September 2022 was performed using the MEDLINE, EMBASE, and Taylor & Francis databases to identify relevant studies comparing groups undergoing cruroplasty with suture repair (SR) alone, AM, NAM, or partially absorbable mesh (PAM). Studies documenting an objective follow-up ≥ 6 months were included. The primary outcome was the HH recurrence rate confirmed by barium esophagram or upper GI endoscopy.

Results

A total of 34 studies met the inclusion criteria, including 6 randomized clinical trials, 25 retrospectives studies, and 3 prospective cohort studies. A total of 2170 subjects underwent laparoscopic HH repair and completed an objective follow-up ≥ 6 months after surgery; the objective recurrence rate was 20.8% (99/477) at a mean follow-up of 25.8 ± 16.4 months for the SR group, 20.6% (244/1187) at 28.1 ± 13.8 months for the AM group, 13.7% (65/475) at 30.8 ± 15.3 months for the NAM group, and 0% (0/31) at 32.5 ± 13.5 months for the PAM group. However, the pairwise meta-analysis revealed that overall mesh use was not superior to SR in preventing long-term HH recurrence.

Conclusion

The use of AM does not appear to reduce HH recurrence compared to SR alone. Although the data favors NAM to decrease objective HH recurrence in the mid-term, the long-term (≥ 48 months) recurrence rate was similar with or without any type of mesh.

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Acknowledgements

The authors thank Kristine Nally for her editorial assistance.

Funding

No outside funding was obtained for this study.

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Authors and Affiliations

  1. Norton Thoracic Institute, St. Joseph’s Hospital and Medical Center, 500 W Thomas Road, Suite 500, Phoenix, AZ, 85013, USA

    Andrés R. Latorre-Rodríguez & Sumeet K. Mittal

  2. Universidad del Rosario. Escuela de Medicina y Ciencias de la Salud, Grupo de Investigación Clínica, Bogotá D.C., Colombia

    Andrés R. Latorre-Rodríguez

  3. School of Medicine School, Creighton University, Phoenix, AZ, USA

    Ajay Rajan & Sumeet K. Mittal

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Contributions

AL, and SM: Conception and design of the study. AL and AR: Data collection and tabulation. AL and SM: Assembly and data analysis. AL and AR: Drafting of the manuscript. AL and SM: Substantial contribution to the revision of the manuscript critically for important intellectual content. All the authors approved the final manuscript.

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Correspondence to Sumeet K. Mittal.

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Dr. Andrés R. Latorre-Rodríguez, Ajay Rajan, and Dr. Sumeet K. Mittal have no conflicts of interest or financial ties to disclose.

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Latorre-Rodríguez, A.R., Rajan, A. & Mittal, S.K. Cruroplasty with or without mesh? A systematic literature review with a novel time-organized proportion meta-analysis. Surg Endosc 38, 1685–1708 (2024). https://doi.org/10.1007/s00464-024-10683-4

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