Meta-analysis of suture repair versus mesh repair for large hiatal hernia

doi:10.3877/cma.j.issn.1674-6899.2015.03.010

Abstract

Abstract:

Objective

This review is to provide an up-to-date assessment of superiority between suture repair and mesh repair of large hiatal hernia.

Methods

An Internet search was performed of the Pubmed, Embase, and Cochrane Library databases to find all published therapeutic trials of suture repair versus mesh repair technique in large hiatal hernia.Only clinical studies of levels I evidence were included.The primary outcome was hernia recurrence rate.

Results

5 clinical trials of 465 large hiatal hernia repair patients were included in the meta-analysis.The pooled overall analysis showed an approximately 2.5-fold to 4-fold increased risk of recurrence in primary hiatal defect suture repair compared to mesh repair.In subgroup analysis, studies in the long-term(>6 months)group showed that the OR was 0.48(95% CI, 0.22 to 1.01, P=0.05). The majority of the trials had at least one serious bias in study design.

Conclusion

Mesh-reinforced hiatal hernia repair is associated with an approximately 2.5-fold to 4-fold decreased risk of recurrence in comparison with simple repair.The long-term results of mesh-augmented hiatal closure remain to be further investigated after more qualified long-term RCTs emerge in future.

Key words: Hernia, hiatal, Mesh repair, Suture repair, recurrence, Meta-analysis

Yang Zhang, Zhimin Yuan, RenJieyi, Xianzhao Deng, Jie Kang, Bo Wu, Youben Fan. Meta-analysis of suture repair versus mesh repair for large hiatal hernia[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2015, 02(03): 158-164.

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Figures/Tables 8

References 23

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试验	平均年龄(岁，范围/Mean±SD)		男/女(例)		BMI(kg/m²，Mean±SD)		试验对象入选指征	疝大小/类型(患者数)
试验	缝合	补片	缝合	补片	缝合	补片	试验对象入选指征	缝合	补片
Frantzides2002	63(42～81)	58(36～92)	NR	NR	NR	NR	疝缺损>8 cm	>8 cm(36)	>8 cm(36)
Granderath.2005	48.7(24～73)	48.3(22～71)	30/20	32/18	NR	NR	复发或持续性GERD相关症状或并发症；生活质量降低；食管下端括约肌(lower esophageal sphincter，LES)压力<6 mmHg合并病理性pH值 (根据DeMeester评分进行分级)	无疝(5)；≤5 cm(18)；>5 cm(27)	无疝(5)；≤5 cm(19)；>5 cm(26)
Oelschlager2006	64±13	67±11	14/43	13/38	31.3±4.9	30.2±5.6	大于5 cm的上消化道裂孔疝；疝内容物为胃或其他脏器并且不会自发回纳；具有明显的食管旁疝症状或体征；年龄大于18岁	Ⅱ型(6)，Ⅲ型(48)，Ⅳ型(4)	Ⅱ型(8)，Ⅲ型(40)，Ⅳ型(3)
Oelschlager2011	63±10	64±10	7/32	8/33	31.5±4.5	31.1±5.8	大于5 cm的上消化道裂孔疝；疝内容物为胃或其他脏器并且不会自发回纳；具有明显的食管旁疝症状或体征；年龄大于18岁	NR	NR
Watson2015	67.8±1.55	68±1.45	14/29	10/31	29.6±0.8	29.4±0.8	非常大的裂孔疝(含有至少50%的胃)	缺损非常大(43)	缺损非常大(41)

试验	平均年龄(岁，范围/Mean±SD)		男/女(例)		BMI(kg/m²，Mean±SD)		试验对象入选指征	疝大小/类型(患者数)
试验	缝合	补片	缝合	补片	缝合	补片	试验对象入选指征	缝合	补片
Frantzides2002	63(42～81)	58(36～92)	NR	NR	NR	NR	疝缺损>8 cm	>8 cm(36)	>8 cm(36)
Granderath.2005	48.7(24～73)	48.3(22～71)	30/20	32/18	NR	NR	复发或持续性GERD相关症状或并发症；生活质量降低；食管下端括约肌(lower esophageal sphincter，LES)压力<6 mmHg合并病理性pH值 (根据DeMeester评分进行分级)	无疝(5)；≤5 cm(18)；>5 cm(27)	无疝(5)；≤5 cm(19)；>5 cm(26)
Oelschlager2006	64±13	67±11	14/43	13/38	31.3±4.9	30.2±5.6	大于5 cm的上消化道裂孔疝；疝内容物为胃或其他脏器并且不会自发回纳；具有明显的食管旁疝症状或体征；年龄大于18岁	Ⅱ型(6)，Ⅲ型(48)，Ⅳ型(4)	Ⅱ型(8)，Ⅲ型(40)，Ⅳ型(3)
Oelschlager2011	63±10	64±10	7/32	8/33	31.5±4.5	31.1±5.8	大于5 cm的上消化道裂孔疝；疝内容物为胃或其他脏器并且不会自发回纳；具有明显的食管旁疝症状或体征；年龄大于18岁	NR	NR
Watson2015	67.8±1.55	68±1.45	14/29	10/31	29.6±0.8	29.4±0.8	非常大的裂孔疝(含有至少50%的胃)	缺损非常大(43)	缺损非常大(41)

作者	发表年	研究类型	LoE	样本大小(例)		平均数/ 中位数	复发类型	补片
作者	发表年	研究类型	LoE	缝合	补片	平均数/ 中位数	复发类型	类型	形状	位置	大小(cm)
Frantzides	2002	单中心随机	1	36	36	30	食管吞钡摄片	PTFE	带孔椭圆形	环形	13×10
Frantzides	2002	对照试验	1	36	36	30	食管吞钡摄片	PTFE	带孔椭圆形	环形	13×10
Granderath	2005	单中心随机	1	50	50	12	食管吞钡摄片	PP	方形	后部	1×3
Granderath	2005	对照试验	1	50	50	12	食管吞钡摄片	PP	方形	后部	1×3
Oelschlager	2006	多中心随机	1	50	45	6	食管吞钡摄片	SIS	U型	后部	7×10
Oelschlager	2006	对照试验	1	50	45	6	食管吞钡摄片	SIS	U型	后部	7×10
Oelschlager	2011	多中心随机	1	39	33	58	食管吞钡摄片	SIS	U型	后部	7×10
Oelschlager	2011	对照试验	1	39	33	58	食管吞钡摄片	SIS	U型	后部	7×10
Watson	2015	多中心随机对照试验	1	43	41	12	食管吞钡摄片 /胃镜	Surgisis	矩形	后部	(2～3 )× (4～5)

作者	发表年	研究类型	LoE	样本大小(例)		平均数/ 中位数	复发类型	补片
作者	发表年	研究类型	LoE	缝合	补片	平均数/ 中位数	复发类型	类型	形状	位置	大小(cm)
Frantzides	2002	单中心随机	1	36	36	30	食管吞钡摄片	PTFE	带孔椭圆形	环形	13×10
Frantzides	2002	对照试验	1	36	36	30	食管吞钡摄片	PTFE	带孔椭圆形	环形	13×10
Granderath	2005	单中心随机	1	50	50	12	食管吞钡摄片	PP	方形	后部	1×3
Granderath	2005	对照试验	1	50	50	12	食管吞钡摄片	PP	方形	后部	1×3
Oelschlager	2006	多中心随机	1	50	45	6	食管吞钡摄片	SIS	U型	后部	7×10
Oelschlager	2006	对照试验	1	50	45	6	食管吞钡摄片	SIS	U型	后部	7×10
Oelschlager	2011	多中心随机	1	39	33	58	食管吞钡摄片	SIS	U型	后部	7×10
Oelschlager	2011	对照试验	1	39	33	58	食管吞钡摄片	SIS	U型	后部	7×10
Watson	2015	多中心随机对照试验	1	43	41	12	食管吞钡摄片 /胃镜	Surgisis	矩形	后部	(2～3 )× (4～5)

研究	复发标准	复发时间(月)	复发率		手术时间(min)		吞咽困难(0～6个月)		吞咽困难(>6个月，患者)
研究	复发标准	复发时间(月)	缝合	补片	缝合	补片	缝合	补片	缝合	补片
Frantzides 2002	ND	≤6	8/36	0/36	126	156	NR	NR	NR	NR
Granderath 2005	存在折叠瓣胸腔内移位	≤12	13/50	4/50	56	58	2/50	6/50	2/50	2/50
Oelschlager 2006	>2 cm	≤6	12/50	4/45	185	201	0.8±2.1	1.4±2.5	NA	NA
Oelschlager 2011	>2 cm	>6，均数＝60	20/34(#) 12/24(*)	14/26 (#)12/24 (*)	185	201	NA	NA	1.6±2.8 (32)	1.4±2.5 (26)
Watson	>2 cm	≤6	3/39	2/39	111.8	110.3	4.8±1.3	4.9±1.5	2.9±0.95	4.8±1.5

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