Long-term outcomes and satisfaction of laparoscopic non-absorbable mesh-reinforced hiatal hernia repair

Background Interest in laparoscopic mesh-reinforced hiatal hernia (HH) repair is driven by concern of recurrences following primary suture repair alone. There is need for further evidence on non-absorbable mesh-related complications or the long-term outcomes and patient satisfaction of laparoscopic mesh-reinforced HH repair. Methods A retrospective analysis of consecutive patients (2005-2016) of a single surgeon. Patients were further surveyed via telephone and mailed questionnaires to assess long-term satisfaction and outcomes using Visick and gastro-oesophageal reflux disease symptoms assessment scale (GSAS) scores. Results 174 patients underwent laparoscopic HH repair, either as part of laparoscopic anti-reflux surgery (ARS) or for treatment of para-oesophageal HH in this period and fulfilled the study criteria. Patients with crural defects > 2cm received primary closure and those with larger defects received mesh reinforcement. Primary repair was performed in 28.2% (n=49) and mesh-reinforcement in 71.8% (n=125). HH recurrence (20.4% vs 17.6%, p=0.67) and reoperation rates (16.3% vs 10.4%, p=0.28) were not significantly different between the two groups. GSAS scores (2.1 vs 1.8. p=0.74) and patient satisfaction (p=0.82) were similar. Resolution of symptoms (Visick 1) favoured the mesh-reinforced group (19.4% vs 46.5%, p=0.04). There were no mesh infections or erosions. Conclusion In our cohort, laparoscopic non-absorbable mesh-reinforced HH repair of large defects had similar long-term results to primary repair of small defects. There were potential long-term improvements in patient symptomatic outcomes as determined by the Visick score.