Analysis Of The Effect And Prognosis Of Laparoscopic Hiatal Hernia Repair With Mesh

Objective To observe the clinical effect and prognosis of laparoscopic repair of esophageal hiatal hernia with or without mesh.Methods Patients with gastroesophageal reflux disease who received laparoscopic esophageal hiatal hernia repair in the Zhongda Hospital Southeast University were analyzed.A prospective study has been carried out since March 2017.As of December 2019,a total of 69 cases have been included.All patients underwent laparoscopic esophageal hiatal hernia repair plus fundoplication(Nissen’s operation),and they were divided into two groups A and B.In group A,simple suture was used to repair the hiatal hernia,while in group B,mesh was used to repair the hiatal hernia.The operative effect,postoperative complication rate,recurrence rate,the quality of life and satisfaction rate of the patients were compared.Results There was no significant difference in bleeding volume and ventilation time between the two groups(P > 0.05),but the operation time of the mesh group was longer than that of the non mesh group(P < 0.05),and the postoperative hospitalization time of the mesh group was also increased(P < 0.05).Before operation,there was no significant difference between the two groups in each symptom score(P > 0.05);3 months after operation,there was no significant difference between the two groups in each symptom score(P > 0.05);6 months after operation,the score of reflux attack in the mesh group was lower than that in the non mesh group,but the score of dysphagia was higher than that in the non mesh group,and the difference between the two groups was statistically significant(P < 0.05).There was no significant difference in other symptom scores between the two groups(P > 0.05).The improvement of reflux attack,heartburn and nausea in the mesh group was better than that in the non mesh group(P < 0.05),but the improvement of dysphagia was worse than that in the non mesh group(P < 0.05).There was no significant difference in the quality of life scores between the mesh group and the non mesh group(P > 0.05).Up to 6 months after operation,the incidence of dysphagia in the mesh group was significantly higher than that in the non mesh group(P < 0.05).There was no significant difference between the two groups in the incidence of abdominal distention,recurrence rate and satisfaction rate of operation(P > 0.05).Conclusion Repair with mesh can significantly improve the reflux and heartburn symptoms of patients with esophageal hiatal hernia,but it should be used cautiously for patients with dysphagia,because the new incidence of dysphagia after mesh repair is higher than that of simple suture repair.The risk of recurrence of hiatal hernia may not be affected by the use of mesh,and the diameter of esophageal hiatal hernia may be an important factor in predicting the recurrence of hernia.