Efficacy of different types of mesh combined with Nissen fundoplication for repairing hiatal hernia and potential risk factors for recurrence

doi:10.3877/cma.j.issn.1674-392X.2024.05.010

Abstract

Abstract:

Objective

To investigate the effect of different meshes combined with Nissen fundoplication for repairing hiatal hernia (HH) and potential risk factors for recurrence.

Methods

A total of 120 patients with HH underwent laparoscopic mesh repair combined with Nissen fundoplication in Second People's Hospital of Hunan Province from October 2019 to June 2022 were selected. According to intraoperative type of mesh, patients were divided into the experimental group (decellularized porcine small intestinal submucosa-derived biological mesh) and the control group (polypropylene mesh). The postoperative efficacy of the two groups of HH patients were retrospectively analyzed, and the potential risk factors for recurrence were further explored by Logistic regression analysis.

Results

The postoperative gastroesophageal reflux disease questionnaire (Gerd Q) scores [(7.6±1.8), (7.8±1.2) points]of both groups of patients decreased compared to preoperative scores [(11.2±3.0), (11.1±3.2) points], with statistically significant difference (t=7.971, 7.479; P＜0.001, ＜0.001).The results of univariate analysis showed that postoperative recurrence of HH was associated with age (OR=3.211, 95% CI=1.831-5.191;P=0.012), postoperative acid reflux (OR=3.385, 95% CI=1.525-6.213; P=0.013), postoperative dysphagia(OR=3.512, 95% CI=1.902-5.914; P=0.022), hiatal defect diameter (OR=5.810, 95% CI=3.2261-9.993;P=0.020), postoperative hospital stay (OR=2.426, 95% CI=1.421-4.270; P=0.027), postoperative esophageal pressure (OR=0.372, 95% CI=0.105-0.823; P=0.019) and postoperative DeMeester score(OR=1.916, 95% CI=1.022-4.885; P=0.013). Further multivariate Logistic regression analysis showed that postoperative acid reflux (OR=3.518, 95% CI=1.050-5.423; P=0.013), postoperative dysphagia(OR=3.307, 95% CI=1.384-7.065; P=0.011), large hiatal defect diameter (OR=3.673, 95% CI=1.821-10.368; P=0.016), long postoperative hospital stay (OR=7.025, 95% CI=4.313-16.335; P=0.017), high postoperative esophageal pressure (OR=14.013, 95% CI=7.735-21.926; P=0.007) and high postoperative DeMeester score (OR=15.342, 95% CI=3.024-24.012; P=0.004) were independent risk factors for HH recurrence.

Conclusion

Both biological and synthetic meshes combined with Nissen fundoplication can safely and effectively repair HH and improve the prognosis of patients. Large diameter of hiatal defect,postoperative acid reflux and dysphagia, long postoperative hospital stay, high postoperative esophageal pressure and DeMeester score suggest higher risk of HH recurrence, and clinical application should follow the principle of individualized treatment.

Key words: Hiatal hernia, Biological mesh, Herniorrhaphy, Nissen fundoplication, Efficacy, Risk factors for recurrence

Yan Zhou, Ying Li, Xiaobing Zhou, Fahui Cheng, Hengzheng He. Efficacy of different types of mesh combined with Nissen fundoplication for repairing hiatal hernia and potential risk factors for recurrence[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 528-533.

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Figures/Tables 7

组别	例数	男性/女性[例(%)]	年龄(岁, $\overset{ˉ}{x}$ ±s)	滑动裂孔疝/食管旁疝/混合疝/巨大裂孔疝[例(%)]
对照组	60	22(36.67)/38(63.33)	51.48±11.21	45(75.00)/7(11.67)/6(10.00)/2(3.33)
试验组	60	25(41.67)/35(58.33)	50.91±12.04	42(70.00)/11(18.33)/4(6.67)/3(5.00)
t/χ²值		0.315	0.739	1.592
P值		0.574	0.461	0.810

组别	例数	男性/女性[例(%)]	年龄(岁, $\overset{ˉ}{x}$ ±s)	滑动裂孔疝/食管旁疝/混合疝/巨大裂孔疝[例(%)]
对照组	60	22(36.67)/38(63.33)	51.48±11.21	45(75.00)/7(11.67)/6(10.00)/2(3.33)
试验组	60	25(41.67)/35(58.33)	50.91±12.04	42(70.00)/11(18.33)/4(6.67)/3(5.00)
t/χ²值		0.315	0.739	1.592
P值		0.574	0.461	0.810

组别	例数	手术时间(min)	术中出血量(ml)	术后住院时间(d)	住院费用(万元)	术后LES静息压力(mmHg)	术后DeMeester评分(分)
对照组	60	103.5±15.7	7.8±1.1	4.3±0.6	2.9±0.5	14.5±1.5	11.4±1.1
试验组	60	106.1±17.2	8.1±1.3	4.4±0.7	3.0±0.6	14.2±1.2	11.2±1.4
t值		0.865	1.365	0.840	0.482	1.210	0.870
P值		0.389	0.175	0.402	0.691	0.229	0.386

组别	例数	反酸、烧心	吞咽困难	腹胀、腹痛	腹泻	总并发症
对照组	60	4(6.7)	4(6.7)	6(10.0)	9(15.0)	23(38.3)
试验组	60	6(10.0)	5(8.3)	7(11.7)	6(10.0)	24(40.0)
χ ²值		-	-	-	-	0.035
P值		-	-	-	-	0.852

组别	Gerd Q评分		Gerd Q评分治疗前后差值
组别	术前	术后	Gerd Q评分治疗前后差值
对照组	11.2±3.0	7.6±1.8^a	3.5±0.8
试验组	11.1±3.2	7.8±1.2^a	3.4±0.6
t值	0.177	0.716	0.775
P值	0.860	0.475	0.440

自变量	复发患者(11例)	未复发患者(109例)	P值	OR	95%CI
年龄[例(%)]			0.012	3.211	1.831～5.191
≥55岁	8(24.24)	25(75.76)
＜55岁	3(3.45)	84(96.55)
术后反酸[例(%)]			0.013	3.385	1.525～6.213
是	4(40.00)	6(60.00)
否	7(6.33)	103(93.64)
术后吞咽困难[例(%)]			0.022	3.512	1.902～5.914
是	4(44.44)	5(55.56)
否	7(6.31)	104(93.69)
裂孔缺损直径[例(%)]			0.020	5.810	3.2261～9.993
＜3cm	2(3.08)	63(96.92)
3～5cm	9(16.36)	46(83.64)
术后住院时间(d, $\overset{ˉ}{x}$ ±s)	5.2±0.3	4.3±0.8	0.027	2.426	1.421～4.270
补片类型[例(%)]			0.622	0.891	0.523～1.113
生物补片	5(10.64)	42(89.36)
合成补片	6(8.22)	67(91.78)
术后食管压力(mmHg, $\overset{ˉ}{x}$ ±s)	19.25±3.52	15.08±4.20	0.019	0.372	0.105～0.823
术后DeMeester评分(分, $\overset{ˉ}{x}$ ±s)	11.86±0.3	11.2±1.5	0.013	1.916	1.022～4.885

自变量	复发患者(11例)	未复发患者(109例)	P值	OR	95%CI
年龄[例(%)]			0.012	3.211	1.831～5.191
≥55岁	8(24.24)	25(75.76)
＜55岁	3(3.45)	84(96.55)
术后反酸[例(%)]			0.013	3.385	1.525～6.213
是	4(40.00)	6(60.00)
否	7(6.33)	103(93.64)
术后吞咽困难[例(%)]			0.022	3.512	1.902～5.914
是	4(44.44)	5(55.56)
否	7(6.31)	104(93.69)
裂孔缺损直径[例(%)]			0.020	5.810	3.2261～9.993
＜3cm	2(3.08)	63(96.92)
3～5cm	9(16.36)	46(83.64)
术后住院时间(d, $\overset{ˉ}{x}$ ±s)	5.2±0.3	4.3±0.8	0.027	2.426	1.421～4.270
补片类型[例(%)]			0.622	0.891	0.523～1.113
生物补片	5(10.64)	42(89.36)
合成补片	6(8.22)	67(91.78)
术后食管压力(mmHg, $\overset{ˉ}{x}$ ±s)	19.25±3.52	15.08±4.20	0.019	0.372	0.105～0.823
术后DeMeester评分(分, $\overset{ˉ}{x}$ ±s)	11.86±0.3	11.2±1.5	0.013	1.916	1.022～4.885

自变量	P值	OR	95%CI
年龄	0.063	1.530	0.511～2.315
术后反酸	0.013	3.518	1.050～5.423
术后吞咽困难	0.011	3.307	1.384～7.065
裂孔缺损直径	0.016	3.673	1.821～10.368
术后住院时间	0.017	7.025	4.313～16.335
术后食管压力	0.007	14.013	7.735～21.926
术后DeMeester评分	0.004	15.342	3.024～24.012

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