Mesh vs Non-Mesh Repair in Type I Hiatal Hernia: Propensity-Matched Study of 6,533 Patients

Overview

This large propensity-score matched study analyzed 6,533 patients undergoing type I hiatal hernia repair with either mesh-augmented or non-mesh cruroplasty. The study found no significant differences in intraoperative or postoperative complications, recurrence rates, or chronic pain at 1-year follow-up between the two techniques.

Background

Type I hiatal hernias, or sliding hernias, are the most common form and are frequently associated with gastroesophageal reflux disease (GERD). Surgical repair typically involves fundoplication combined with cruroplasty to narrow the hiatal orifice. While mesh reinforcement of the cruroplasty may reduce recurrence, concerns about mesh-related complications such as dysphagia and esophageal erosion have limited its routine use. Current guidelines recommend mesh only in selected cases with large defects or weak crurae, but high-quality evidence remains lacking.

Data Highlights

Key Findings

• Propensity-score matching balanced key variables including age, BMI, defect size, ASA status, and fundoplication type.
• No significant difference in intraoperative or general postoperative complications between mesh and non-mesh groups.
• Recurrence rates at 1-year follow-up were similar regardless of mesh use.
• Chronic pain outcomes, including pain at rest and on exertion, did not differ significantly between groups.
• Mesh augmentation did not increase complication-related reoperations or mesh-associated adverse events within 1 year.
• Findings support selective rather than routine use of mesh in type I hiatal hernia repair.

Clinical Implications

Surgeons may consider that mesh augmentation of cruroplasty in type I hiatal hernia repair does not confer clear advantages in reducing recurrence or complications at 1 year compared to non-mesh repair. Given the lack of increased benefit and potential mesh-related risks, mesh use should be individualized based on patient factors such as hiatal defect size and crural integrity. Routine mesh reinforcement is not supported by this large registry data.

Conclusion

This large propensity-matched analysis from the Herniamed registry demonstrates comparable safety and efficacy of mesh and non-mesh cruroplasty in type I hiatal hernia repair at 1-year follow-up. These results reinforce current guideline recommendations to limit mesh use to selected cases rather than routine application.

References

1. Herniamed Study Group 2023 -- Herniamed Registry Data on Hiatal Hernia Repair
2. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Guidelines 2020 -- Mesh Use in Hiatal Hernia Repair
3. European Association of Endoscopic Surgery (EAES) 2021 -- Hiatal Hernia Repair Recommendations