Prospective cohort study of biological versus and synthetic meshes for laparoscopic repair of hiatal hernia

The synthetic meshes were widely applied in laparoscopic repair of hiatal hernia. In contrast, there were few researches on the application of biological meshes and it’s clinical effects needed to be further verified especially in the giant hiatal hernia. Our aim of this study was to assess the clinical outcomes and safety of biological versus synthetic meshes in a short-term comparative period.

This prospective cohort study of 174 patients with 87 patients in each group underwent laparoscopic repair of hiatal hernia from April 2022 to February 2024 in single‑center. The biological mesh group and the synthetic mesh group were respectively repaired with Small Intestinal Submucosa (SIS) mesh and anti-adhesion polypropylene mesh for crura reinforcement. The general baseline characteristics, perioperative data, complications, recurrence rate, symptom and quality of life improvement data (the Visual Analog Scale, VAS and the Short Form 36 Health Survey, SF-36), satisfaction were collected. Follow-up data were collected at 6 and 12 months postoperatively.

In comparison between the two groups, no significant differences were observed in the general baseline characteristics including sex, age, BMI, chronic disease, preoperative PPI use, preoperative anaemia (P > 0.05) and perioperative data including operation times, blooding loss, defect length, defect width and mesh-related reactions (extensive perimesh fluid collection and postoperative fever) (P > 0.05). The postoperative hospital stay of the biological group was longer than the synthetic group (4.5 ± 1.6vs. 4.1 ± 1.1; P = 0.111) with no statistical difference. There was no mortality and mesh-related complications such as dysphagia, mesh infection, esophageal erosion, esophageal perforation in each group. Both groups demonstrated similar and significant improvement in quality of life scores and symptoms scores with high satisfaction at 6 and 12 months postoperatively (P > 0.05). The recurrence rate was 0% in the biological mesh group and 1.1% in the synthetic mesh group at 6 months (P = 0.316). At 12 months, the recurrence rate was 1.1% in each group (P = 1.000). All recurrent cases were diagnosed as type IV hiatal hernia preoperatively.

Biological and synthetic meshes demonstrated similar and satisfactory results in clinical effect and improvement of quality of life with low recurrence and complication rates in laparoscopic hiatal hernia repair. The biological mesh is effective and safe in the repair of giant hiatal hernia. Compared with synthetic meshes, the application of biological meshes does not increase the postoperative hospital stay due to the mesh-related reactions in a short-term comparative period.