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The following is a summary of “Pre-existing hiatal mesh increases morbidity during and after revisional antireflux surgery: A retrospective multicenter study,” published in the September 2024 issue of Surgery by Liu et al.
Revisional antireflux surgery, including the repair of hiatal hernias, is becoming increasingly common as the demand for corrective procedures rises. The use of mesh to augment hiatal closure during the initial surgery remains controversial despite its frequent application. While previous meta-analyses of randomized trials have shown no significant benefit from routine mesh placement, its potential to cause harm remains uncertain, particularly in revisional surgery. This study aimed to assess whether pre-existing mesh at the hiatus increases the risk of complications during and after revisional antireflux surgery. A comprehensive analysis was conducted using prospectively maintained databases, encompassing all elective revisional antireflux surgeries performed across 36 hospitals in Australia over 10 years.
The outcomes of patients with and without prior hiatal mesh were compared, and a propensity score-matched analysis was used to validate the findings. A total of 346 revisional cases were analyzed, of which 35 involved pre-existing mesh. Baseline characteristics between the two groups were similar. However, patients with pre-existing mesh demonstrated a significantly higher risk of intraoperative complications (48.6% vs. 22.5%, odds ratio [OR] 3.25, 95% CI 1.63–6.38, P = .002), predominantly due to bleeding and lacerations to adjacent structures such as the pleura, lung, and liver. Postoperative morbidity was also notably increased in the mesh group (37.1% vs. 16.1%, OR 3.09, 95% CI 1.50–6.43, P = .005), with complications largely arising from bleeding and respiratory issues.
Importantly, pre-existing mesh was identified as an independent predictor of both intraoperative and postoperative complications, underscoring the risks associated with its use. Given the growing prevalence of revisional antireflux surgery, these findings suggest that routine mesh placement during primary antireflux procedures may contribute to higher morbidity in future surgeries. Consequently, caution is advised regarding the routine use of mesh in initial antireflux surgeries to minimize potential risks during revision.
Source: sciencedirect.com/science/article/abs/pii/S0039606023003240
