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Suture Cruroplasty Versus Mesh Hiatal Herniorrhaphy for Large Hiatal Hernias (HHs)

An Updated Meta-Analysis and Systematic Review of Randomized Controlled Trials

Memon, Muhammed A. MBBS, MA Clin Ed, DCH, FACS, FRACS, FRCSI, FRCSEd, FRCSEng*,†,‡,§,∥; Siddaiah-Subramanya, Manjunath MBBS, MRCS, FRACS, MMIS†,¶; Yunus, Rossita M. PhD#; Memon, Breda RN, LLB, PGCEd, Dip Pract Man*; Khan, Shahjahan PhD

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: August 2019 - Volume 29 - Issue 4 - p 221–232
doi: 10.1097/SLE.0000000000000655
Review Articles

Background: To explore the clinical outcomes, safety and effectiveness of suture cruroplasty versus mesh repair for large hiatal hernias (HHs) by an updated meta-analysis.

Material and Methods: Randomized controlled trials evaluating the effects of these 2 treatment modalities were searched from PubMed and other electronic databases between January 1991 and July 2018. The outcome variables analyzed included operating time, complications, recurrence of HH or wrap migration, reoperation, hospital stay and quality of life.

Results: Five randomized controlled trials totaling 478 patients (suture=222, mesh=256) were analyzed. For reoperation variable, the odds ratio was significantly 3.26 times higher for the suture group. For recurrence of HH, the odds ratio for the suture group was nonsignificantly 1.65 times higher compared with the mesh group. Comparable effects were noted for all other variables.

Conclusions: Mesh repair seems to be superior to suture cruroplasty for large HH repair. Therefore, the routine use of mesh may be advantageous in selected cases.

*South East Queensland Surgery (SEQS) and Sunnybank Obesity Centre, Sunnybank

Mayne Medical School, School of Medicine, University of Queensland, Brisbane

Faculty of Health Sciences and Medicine, Bond University, Gold Coast

International Centre for Applied Climate Sciences and Centre for Health Sciences Research, School of Agricultural, Computing and Environmental Sciences, University of Southern Queensland, Toowoomba, Qld

Charles Gardiner Hospital, Perth, WA, Australia

§Faculty of Health and Social Science, Bolton University, Bolton, Lancashire, UK

#Institute of Mathematical Sciences, University of Malaya, Kuala Lumpur, Malaysia

The author declares no conflicts of interest.

Reprints: Muhammed A. Memon, MBBS, MA Clin Ed, DCH, FACS, FRACS, FRCSI, FRCSEd, FRCSEng, Sunnybank Obesity Centre, Suite 9, McCullough Centre, 259 McCullough Street, Sunnybank, Qld 4109, Australia (e-mail:

Received January 14, 2019

Accepted February 5, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.