Laparoscopic hiatal hernia repair: mesh or no mesh? A narrative review

Abstract

Objective: The objective of this narrative review is to summarize the data supporting or refuting the usage of mesh in laparoscopic hiatal hernia repairs. Background: Laparoscopic hiatal hernia repair was first reported in 1992, and was immediately adopted over open abdominal or thoracic approach due to lower morbidity, blood loss, and ICU stay. The Achilles heel of the laparoscopic repair became apparent in the early 2000’s, when studies began to report an up to 50% radiologic recurrence rate. Mesh reinforcement was a natural addition, proposed as a means of reducing tension and improving the recurrence rate, using either biologic or permanent mesh around the hiatal closure. Methods: A variety of studies investigated the impact of mesh on hiatal hernia recurrence, differing in type of mesh, mesh shape and configuration, and method of securing to the diaphragm. This review discusses the available literature on three essential questions for the routine use of mesh in the laparoscopic repair of hiatus hernias: (I) Does mesh reduce long-term recurrence rates? (II) Is the reduction in recurrence rates clinically significant? (III) What is the incidence of mesh-related complications? Conclusions: Overall, the existing data comes from mostly short-term, single-center trials, and suffers in particular from a lack of consistency in definitions (defining a hiatal hernia and defining a recurrence), diagnosis modality, and symptom documentation. The existing literature is insufficient to support the routine use of mesh in laparoscopic hiatal hernia repairs.