Suture Cruroplasty Versus Prosthetic Hiatal Herniorrhaphy for Large Hiatal Hernia: A Meta-Analysis and Systematic Review of Randomized Controlled Trials

Memon, Muhammed Ashraf, Memon, Breda, Yunus, Rossita Mohamad and Khan, Shahjahan (2015) Suture Cruroplasty Versus Prosthetic Hiatal Herniorrhaphy for Large Hiatal Hernia: A Meta-Analysis and Systematic Review of Randomized Controlled Trials. Annals of Surgery, 263 2: 258-266. doi:10.1097/SLA.0000000000001267


Author Memon, Muhammed Ashraf
Memon, Breda
Yunus, Rossita Mohamad
Khan, Shahjahan
Title Suture Cruroplasty Versus Prosthetic Hiatal Herniorrhaphy for Large Hiatal Hernia: A Meta-Analysis and Systematic Review of Randomized Controlled Trials
Journal name Annals of Surgery   Check publisher's open access policy
ISSN 0003-4932
1528-1140
Publication date 2015-10-01
Year available 2015
Sub-type Article (original research)
DOI 10.1097/SLA.0000000000001267
Open Access Status Not Open Access
Volume 263
Issue 2
Start page 258
End page 266
Total pages 9
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams and Wilkins
Collection year 2016
Language eng
Formatted abstract
Objective: The aim was to conduct a meta-analysis of randomized controlled trials (RCTs) comparing 2 methods of hiatal closure for large hiatal hernia and to evaluate their strengths and flaws.

Methods: Prospective RCTs comparing suture cruroplasty versus prosthetic hiatal herniorrhaphy for large hiatal hernia were selected by searching PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1991 and October 2014. The outcome variables analyzed included operating time, complications, recurrence of hiatal hernia or wrap migration, and reoperation. These outcomes were unanimously decided to be important because they influence the practical approach toward patient management.
Random effects model was used to calculate the effect size of both dichotomous and continuous data. Heterogeneity among the outcome variables of these trials was determined by the Cochran’s Q statistic and I 2 index. The meta-analysis was prepared in accordance with Preferred Reporting of Systematic Reviews and Meta-Analyses guidelines.

Results: Four RCTs were analyzed totaling 406 patients (Suture ¼ 186, Prosthesis ¼ 220). For only 1 of the 4 outcomes, ie, reoperation rate (OR 3.73, 95% CI 1.18, 11.82, P ¼ 0.03), the pooled effect size favored prosthetic hiatal herniorrhaphy over suture cruroplasty. For other outcomes, comparable effect sizes were noted for both groups which included recurrence of hiatal hernia or wrap migration (OR 2.01, 95% CI 0.92, 4.39, P ¼ 0.07), operating time (SMD 0.46, 95% CI 1.16, 0.24, P ¼ 0.19) and complication rates (OR 1.06, 95% CI 0.45, 2.50, P ¼ 0.90).

Conclusions: On the basis of our meta-analysis and its limitations, we believe that the prosthetic hiatal herniorrhaphy and suture cruroplasty produces comparable results for repair of large hiatal hernias. In the future, a number of issues need to be addressed to determine the clinical outcomes, safety, and effectiveness of these 2 methods for elective surgical treatment of large hiatalhernias. Presently, the use of prosthetic hiatal herniorrhaphy for large hiatal hernia cannot be endorsed routinely and the decision for the placement of mesh needs to be individualized based on the operative findings and the surgeon’s recommendation.

Keyword Hernia
Hiatal
Human
Laparoscopic methods
Paraoesophageal
Prosthetic reinforcement
Suture cruroplasty
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 1 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 1 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 27 Oct 2015, 00:26:40 EST by System User on behalf of School of Medicine