The Role of Biologic Mesh and Fundoplication in the Surgical Management of Hiatal Hernias: A Multicenter Evaluation.
The Role of Biologic Mesh and Fundoplication in the Surgical Management of Hiatal Hernias: A Multicenter Evaluation.
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生物补片和胃底折叠术在食管裂孔疝手术治疗中的作用：多中心评估。
DOI：
10.1159/000533186
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发表时间：
2023
影响因子：
2.7
通讯作者：
Holihan,JulieL
中科院分区：
文献类型：
--
作者：
Mohr,Cassandra;Ciomperlik,Hailie;Dhanani,Naila;Olavarria,OscarA;Hannon,Craig;Hope,William;Roth,Scott;Liang,MikeK;Holihan,JulieL
食管裂孔疝修补术与食管裂孔疝复发和胃食管反流（格尔）症状有关。虽然小型随机对照试验证明使用补片或胃底折叠术类型的结果差异有限，但仍存在不确定性。MethodsA多中心回顾性研究了2015年至2020年期间接受食管裂孔疝手术治疗的患者。比较了使用补片和仅缝合修复的患者，并比较了部分胃底折叠术与完全胃底折叠术。主要结局是疝复发和术后格尔症状和吞咽困难的发生。进行多变量回归，以评估每个干预措施对临床outcomes.ResultsA共453例患者从四个网站的中位数（IQR）为17（13）个月。在多变量分析中，补片对疝复发没有影响（比值比0.993，95% CI：0.53-1.87，p= 0.982），胃底折叠术类型不影响术后格尔症状复发（完全：比值比0.607，95% CI：0.33-1.12，p= 0.112）或吞咽困难（完整：比值比1.17，95% CI：结论在食管裂孔疝修补术中，补片和胃底折叠术类型似乎对格尔症状没有实质性影响，吞咽困难或疝气复发。这项多中心研究提供了真实世界的证据来支持小型RCT的结果。
IntroductionHiatal hernia repair is associated with substantial recurrence of both hiatal hernia and symptoms of gastroesophageal reflux (GER). While small randomized controlled trials demonstrate limited differences in outcomes with use of mesh or fundoplication type, uncertainty remains.MethodsA multicenter, retrospective review of patients undergoing surgical treatment of hiatal hernias between 2015 and 2020 was performed. Patients with mesh and with suture-only repair were compared, and partial versus complete fundoplication was compared. Primary outcomes were hernia recurrence and occurrence of postoperative GER symptoms and dysphagia. Multivariable regression was performed to assess the effect of each intervention on clinical outcomes.ResultsA total of 453 patients from four sites were followed for a median (IQR) of 17 (13) months. On multivariate analysis, mesh had no impact on hernia recurrence (odds ratio 0.993, 95% CI: 0.53–1.87, p= 0.982), and fundoplication type did not impact recurrence of postoperative GER symptoms (complete: odds ratio 0.607, 95% CI: 0.33–1.12, p= 0.112) or dysphagia (complete: odds ratio 1.17, 95% CI: 0.56–2.43, p= 0.677).ConclusionDuring hiatal hernia repair, mesh and fundoplication type do not appear to have substantial impact on GER symptoms, dysphagia, or hernia recurrence. This multicenter study provides real-world evidence to support the findings of small RCTs.