Impact of mesh use in paraesophageal hernia repair: a review of short- and long-term outcomes
DOI:
https://doi.org/10.18203/2349-2902.isj20251926Keywords:
Paraesophageal hernia, PEHR, Mesh reinforcement, Surgical outcomes, Recurrence rates, Short-term outcomes, Long-term outcomes, Mesh complications, Hernia repair, Minimally invasive surgeryAbstract
This review examines the role of mesh reinforcement in laparoscopic paraesophageal hernia repair (PEHR) by evaluating existing evidence on short-term and long-term outcomes. An extensive analysis of randomized controlled trials, cohort studies, and meta-analyses reveals that mesh use does not significantly impact perioperative morbidity, mortality, or immediate postoperative complications compared to primary suture repair. Additionally, long-term follow-up data show no substantial reduction in hernia recurrence or improvement in quality of life with mesh reinforcement. Although non-absorbable meshes are associated with a higher risk of mesh-related complications, biologic and biosynthetic meshes demonstrate fewer adverse events. Current evidence supports a selective use of mesh in high-risk or redo repairs rather than routine application. These findings underscore the importance of individualized patient assessment and careful consideration of the potential risks and benefits when deciding on mesh reinforcement in PEHR.
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References
Angeramo CA, Schlottmann F. Laparoscopic Paraesophageal Hernia Repair: To Mesh or Not to Mesh. Systematic Review and Meta-Analysis. Ann Surg. 2022;275(1):67-72. DOI: https://doi.org/10.1097/SLA.0000000000004913
Amundson JR, Kuchta K, Wu H, VanDruff VN, Haggerty SP, Linn J, et al. A 13-Year Experience With Biologic and Biosynthetic Absorbable Mesh Reinforced Laparoscopic Paraesophageal Hernia Repair. Surg Endosc. 2023;37(9):7271-9. DOI: https://doi.org/10.1007/s00464-023-10248-x
Schlosser KA, Maloney SR, Prasad T, Vedra AA, Brant TH, Colavita PD, et al. Mesh Reinforcement of Paraesophageal Hernia Repair: Trends and Outcomes From a National Database. Surgery. 2019;166(5):879-85. DOI: https://doi.org/10.1016/j.surg.2019.05.014
Abu Saleh WK, Morris LM, Tariq N, Kim MP, Chan EY, Meisenbach LM, et al. Routine Use of Mesh During Hiatal Closure Is Safe With No Increase in Adverse Sequelae. Surgical Endoscopy. 2018;32(2):879-88. DOI: https://doi.org/10.1007/s00464-017-5758-8
Aaron AE, Amabile A, Andolfi C. Gastrointestinal Surgical Emergencies. American College of Surgeons. International Relations Committee. 2023.
Amprayil MA, Irvine T, Thompson SK, Tim B, Aly A, Devitt PG, et al. Quality of Life Following Repair of Large Hiatal Hernia Is Not Influenced by the Use of Mesh-Longer-Term Follow-Up From a Randomized Trial. World J Surg. 2024;48(6):1448-57. DOI: https://doi.org/10.1002/wjs.12185
Tam V, Luketich JD, Levy RM. Mesh Cruroplasty in Laparoscopic Repair of Paraesophageal Hernias Is not Associated With Better Long-Term Outcomes Compared to Primary Repair. Am J Surg. 2017;214(4):651-6. DOI: https://doi.org/10.1016/j.amjsurg.2017.06.011
Müller-Stich BP, Kenngott HG, Gondan M, Christian S, Linke GR, Fritz F, et al. Use of Mesh in Laparoscopic Paraesophageal Hernia Repair: A Meta-Analysis and Risk-Benefit Analysis. PLOS ONE. 2015;10(10):e0139547. DOI: https://doi.org/10.1371/journal.pone.0139547
Inaba CS, Oelschlager BK, Yates RB, Khandelwal S, Chen JY, Wright AS. Characteristics and Outcomes of Patients Undergoing Paraesophageal Hernia Repair With Selective Use of Biologic Mesh. Surgicl Enadoscopy. 2022;36(2):1627-32. DOI: https://doi.org/10.1007/s00464-021-08399-w
Ceron REC, Yates RB, Wright AS, Rodriguez HA, Lopez RG, Pellegrini CA, et al. Type II hiatal hernias: dothey exist or are they actually parahiatal hernias? Surgical Endoscopy. 2023;37(3):1956-61. DOI: https://doi.org/10.1007/s00464-022-09641-9
Aiolfi A, Bona D, Sozzi A, Bonavina L. PROsthetic MEsh Reinforcement in elective minimally invasive paraesophageal hernia repair (PROMER): an international survey. Updates in Surg. 2024;76(7):2675-82. DOI: https://doi.org/10.1007/s13304-024-02010-2
Rieder E, Schoppmann SF. Management of paraesophageal hernia 2025. Curr Opin Gastroenterol. 2005;41(4):234-8. DOI: https://doi.org/10.1097/MOG.0000000000001111
Vigneswaran Y, Gottlieb LJ, Hussain M. Novel Posterior Rectus Sheath Flap for Paraesophageal Hernia Repairs. JAMA Surg. 2025;160(3):349-50. DOI: https://doi.org/10.1001/jamasurg.2024.2561
Corbett JM, Eriksson SE, Sarici IS, Jobe BA, Ayazi S. (2024). Complications After Paraesophageal Hernia Repair. Thoracic Surg Clin. 2024;34(4):355-69. DOI: https://doi.org/10.1016/j.thorsurg.2024.06.002
Vigneswaran Y, Hussain M, Varsanik MA, Corvin C, Gottlieb LJ, Alverdy JC. IDEAL phase 2a results: posterior rectus sheath flap for hiatal augmentation in complex paraesophageal hernias. Ann Surg. 2024;279(6):1000-7. DOI: https://doi.org/10.1097/SLA.0000000000006247
Schlottmann F, Herbella FA, Patti MG. Management of Paraesophageal Hernia-Still a Controversial Topic. JAMA Surg. 2025;160(3):255-6. DOI: https://doi.org/10.1001/jamasurg.2024.5765
Smith BA, Sbrana F, Quinn EJ. Robotic surgery for giant paraesophageal hernias: a promising approach to improved outcomes. J Robotic Surg. 2025;19(1):1-8. DOI: https://doi.org/10.1007/s11701-025-02247-y
Barazanchi AW, Chui JN, Bhimani N, Leibman S, Smith G. Impact of pre-existing mesh at the hiatus at revisional hiatal hernia surgery. Dis Esophagus. 2024;37(10):doae050. DOI: https://doi.org/10.1093/dote/doae050
Ioffe OY, Tarasov TA, Markulan LY, Bagirov MM. Differentiated approach to hernioplasty of paraesophageal hernias. General Surg. 2024;(2):38-46. DOI: https://doi.org/10.30978/GS-2024-2-38
Huang X, Shao X, Li J. One-year outcomes of biological mesh in hiatal hernia repair: a real-world study. Hernia. 2025;29(1):123. DOI: https://doi.org/10.1007/s10029-025-03316-9
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