632 SUTURED VERSUS MESH-AUGMENTED HIATUS HERNIA REPAIR: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Repair of large hiatus hernias is increasingly being performed. However, there is no consensus for the optimal technique for hiatal closure between sutured versus mesh-augmented (absorbable or non-absorbable) repair. This meta-analysis systematically reviewed published randomized control trials (RCTs) comparing sutured versus mesh-augmented hiatus hernia (HH) repair. Our primary endpoint was HH recurrence at short- and long-term follow-up. Secondary endpoints were: surgical complications, operative times, dysphagia and quality of life. Methods A systematic review of Medline, Scopus (which encompassed Embase), Cochrane Central Register of Controlled Trials, Web of Science and PubMed was performed to identify relevant studies comparing mesh-augmented versus sutured HH repair. Data were extracted and compared by meta-analysis, using odds ratio and mean differences with 95% confidence intervals. Results Seven RCTs were found which compared mesh-augmented (non-absorbable mesh: n = 296; absorbable mesh: n = 92) with sutured repair (n = 347). There were no significant differences for short-term hernia recurrence (defined as 6–12 months, 10.1% mesh versus 15.5% sutured, P = 0.22), long-term hernia recurrence (defined as 3–5 years, 30.7% mesh vs 31.3% sutured, P = 0.69), functional outcomes and patient satisfaction. The only statistically significant difference was that the mesh repair required a longer operation time (P = 0.05, OR 2.33, 95% CI 0.03–24.69). Conclusion Mesh repair for hiatus hernia does not offer any advantage over sutured hiatal closure. As both techniques deliver good and comparable clinical outcomes, a suture only technique is still an appropriate approach.

337 MESH REINFORCEMENT OF THE HIATOPLASTY. PROTECTING THE ACHILLES' HEEL

Disruption of hiatoplasty is one of the main causes of anti reflux surgeries failure. There are some conditions that are associated with higher risks of disruption, leading to hernia recurrence. Bioabsorbable meshes have a safer profile compared to the permanent ones and we show in this video its use aiming to prevent early and possibly, late recurrence. Methods We present a video about different indications for reinforcement of hiatal closure with bioabsorbable mesh. With the security of bioabsorbable materials and previous experiences with these kind of meshes used in an U configuration, we are suggesting that it can be used as an inverted C over the posterior and anterior sutures placed to close the hiatal defect. The mesh is cut during the surgery to better accommodate as an onlay protection. It can be fixed to the diaphragm in different ways, but we used fibrin glue in this series. Results Sixteen patients were operated with this technique. The long term results are not available at this point, but short term results are very encouraging. We have noticed a slightly higher complaint of dysphagia among these patient compared to what we use to observe in our non-mesh patients, but dilatation was not necessary in any patient. Conclusion The use of bioabsorbable mesh in the hiatus is safe and can be used with more frequently to prevent hiatal recurrences in specific groups of patients. Video https://www.dropbox.com/s/jsblif0pfjcuicu/BIOMESH.mov?dl=0.

ANALYSIS OF EARLY POST-OPERATIONAL COMPLICATIONS IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERY FOR HIATAL HERNIA

In order to identify the advantages of the original modification of Nissen fundoplication techniques and identify the safest mash material for prosthetic reinforcement of hiatal closure, was made analysis of early postoperative complications in 121 patients with hiatal hernia.The formation of the non tension fundoplication reduces the level of early postoperative complications. The usage of biological prosthesis has the advantage in comparison with synthetic ones. In general, the usage of mashes significantly increases the severity of the complaints of patients after the intervention, but most of them are within 3-14 days of the postoperative period.