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Hypothesis

Large hiatal hernias are prone to disruption, resulting in reherniation, when repaired with simple cruroplasty. The use of mesh may decrease the rate of reherniation in the laparoscopic repair of large hiatal hernias.

Design

Prospective, randomized controlled trial.

Setting

University-affiliated private hospital.

Patients

Seventy-two individuals undergoing laparoscopic Nissen fundoplication with a hernia defect greater or equal to 8 cm in diameter.

Intervention

Nissen fundoplication with posterior cruroplasty (n = 36) vs Nissen fundoplication with posterior cruroplasty and onlay of polytetrafluoroethylene (PTFE) mesh (n = 36).

Main Outcome Measures

Recurrences, complications, hospital stay, operative time, and cost.

Results

Patients in both groups had similar hospital stays, but the PTFE group had a longer operative time. The cost of the repair was $960 ± $70 more in the group with the prosthesis. Complications were minor and similar in both groups. There were 8 hernia recurrences (22%) in the primary repair group and none in the PTFE group (P<.006).

Conclusion

The use of prosthetic reinforcement of cruroplasty in large hiatal hernias may prevent hernia recurrences.

	Year	Citations

References