Use of mesh in laparoscopic paraesophageal hernia repair

• Verfasst von: Müller, Beat P. [VerfasserIn]
• Verfasst von: Kenngott, Hannes Götz [VerfasserIn]
• Verfasst von: Stock, Christian [VerfasserIn]
• Verfasst von: Linke, Georg R. [VerfasserIn]
• Verfasst von: Fritz, Franziska [VerfasserIn]
• Verfasst von: Nickel, Felix [VerfasserIn]
• Verfasst von: Diener, Markus K. [VerfasserIn]
• Verfasst von: Wente, Moritz N. [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Verfasst von: Fischer, Lars [VerfasserIn]
• Titel: Use of mesh in laparoscopic paraesophageal hernia repair
• Titelzusatz: a meta-analysis and risk-benefit analysis
• Verf.angabe: Beat P. Müller-Stich, Hannes G. Kenngott, Matthias Gondan, Christian Stock, Georg R. Linke, Franziska Fritz, Felix Nickel, Markus K. Diener, Carsten N. Gutt, Moritz Wente, Markus W. Büchler, Lars Fischer
• E-Jahr: 2015
• Jahr: October 15, 2015
• Umfang: 17 S.
• Fussnoten: Gesehen am 05.08.2020
• Titel Quelle: Enthalten in: PLOS ONE
• Ort Quelle: San Francisco, California, US : PLOS, 2006
• Jahr Quelle: 2015
• Band/Heft Quelle: 10(2015,10) Artikel-Nummer e0139547, 17 Seiten
• ISSN Quelle: 1932-6203
• DOI: doi:10.1371/journal.pone.0139547
• Datenträger: Online-Ressource
• Sprache: eng
• Bibliogr. Hinweis: Errata: Müller, Beat P., 1971 - : Correction: use of mesh in laparoscopic paraesophageal hernia repair
• K10plus-PPN: 1726265374

Abstract

Introduction Mesh augmentation seems to reduce recurrences following laparoscopic paraesophageal hernia repair (LPHR). However, there is an uncertain risk of mesh-associated complications. Risk-benefit analysis might solve the dilemma. Materials and Methods A systematic literature search was performed to identify randomized controlled trials (RCTs) and observational clinical studies (OCSs) comparing laparoscopic mesh-augmented hiatoplasty (LMAH) with laparoscopic mesh-free hiatoplasty (LH) with regard to recurrences and complications. Random effects meta-analyses were performed to determine potential benefits of LMAH. All data regarding LMAH were used to estimate risk of mesh-associated complications. Risk-benefit analysis was performed using a Markov Monte Carlo decision-analytic model. Results Meta-analysis of 3 RCTs and 9 OCSs including 915 patients revealed a significantly lower recurrence rate for LMAH compared to LH (pooled proportions, 12.1% vs. 20.5%; odds ratio (OR), 0.55; 95% confidence interval (CI), 0.34 to 0.89; p = 0.04). Complication rates were comparable in both groups (pooled proportions, 15.3% vs. 14.2%; OR, 1.02; 95% CI, 0.63 to 1.65; p = 0.94). The systematic review of LMAH data yielded a mesh-associated complication rate of 1.9% (41/2121; 95% CI, 1.3% to 2.5%) for those series reporting at least one mesh-associated complication. The Markov Monte Carlo decision-analytic model revealed a procedure-related mortality rate of 1.6% for LMAH and 1.8% for LH. Conclusions Mesh application should be considered for LPHR because it reduces recurrences at least in the mid-term. Overall procedure-related complications and mortality seem to not be increased despite of potential mesh-associated complications.