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Use of mesh in laparoscopic paraesophageal hernia repair: a meta-analysis and risk-benefit analysis

Introduction Mesh augmentation seems to reduce recurrences following laparoscopic paraesophageal hernia repair (LPHR). However, there is an uncertain risk of mesh-associated complications. Risk-benefit analysis might solve the dilemma. Materials and Methods A systematic literature search was perform...

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Main Authors: Müller, Beat P. (Author) , Kenngott, Hannes Götz (Author) , Stock, Christian (Author) , Linke, Georg R. (Author) , Fritz, Franziska (Author) , Nickel, Felix (Author) , Diener, Markus K. (Author) , Wente, Moritz N. (Author) , Büchler, Markus W. (Author) , Fischer, Lars (Author)
Format: Article (Journal)
Language:English
Published: October 15, 2015
In: PLOS ONE
Year: 2015, Volume: 10, Issue: 10
ISSN:1932-6203
DOI:10.1371/journal.pone.0139547
Online Access:Verlag, Volltext: https://doi.org/10.1371/journal.pone.0139547
Verlag, Volltext: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0139547
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Author Notes:Beat P. Müller-Stich, Hannes G. Kenngott, Matthias Gondan, Christian Stock, Georg R. Linke, Franziska Fritz, Felix Nickel, Markus K. Diener, Carsten N. Gutt, Moritz Wente, Markus W. Büchler, Lars Fischer
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Summary:Introduction Mesh augmentation seems to reduce recurrences following laparoscopic paraesophageal hernia repair (LPHR). However, there is an uncertain risk of mesh-associated complications. Risk-benefit analysis might solve the dilemma. Materials and Methods A systematic literature search was performed to identify randomized controlled trials (RCTs) and observational clinical studies (OCSs) comparing laparoscopic mesh-augmented hiatoplasty (LMAH) with laparoscopic mesh-free hiatoplasty (LH) with regard to recurrences and complications. Random effects meta-analyses were performed to determine potential benefits of LMAH. All data regarding LMAH were used to estimate risk of mesh-associated complications. Risk-benefit analysis was performed using a Markov Monte Carlo decision-analytic model. Results Meta-analysis of 3 RCTs and 9 OCSs including 915 patients revealed a significantly lower recurrence rate for LMAH compared to LH (pooled proportions, 12.1% vs. 20.5%; odds ratio (OR), 0.55; 95% confidence interval (CI), 0.34 to 0.89; p = 0.04). Complication rates were comparable in both groups (pooled proportions, 15.3% vs. 14.2%; OR, 1.02; 95% CI, 0.63 to 1.65; p = 0.94). The systematic review of LMAH data yielded a mesh-associated complication rate of 1.9% (41/2121; 95% CI, 1.3% to 2.5%) for those series reporting at least one mesh-associated complication. The Markov Monte Carlo decision-analytic model revealed a procedure-related mortality rate of 1.6% for LMAH and 1.8% for LH. Conclusions Mesh application should be considered for LPHR because it reduces recurrences at least in the mid-term. Overall procedure-related complications and mortality seem to not be increased despite of potential mesh-associated complications.
Item Description:Gesehen am 05.08.2020
Physical Description:Online Resource
ISSN:1932-6203
DOI:10.1371/journal.pone.0139547

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