Laparoscopic Repair of Very Large Hiatus Hernia - A Randomized Controlled Trial

Aug 25, 2026

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Objective: compare absorbable mesh and nonabsorbable mesh with suture repair for very large hiatus hernias, focusing on recurrence prevention and clinical tolerability. Background: radiological recurrence after suture repair reaches up to 30%, while mesh adoption is limited by potential adverse events and outcome variability. Methods: multicentre prospective double-blind randomized trial of three repair methods. Primary endpoint: hernia recurrence by barium meal radiology and endoscopy at 6 months; secondary endpoints: symptom scores through 12 months. Results and conclusions assess recurrence and symptom differences across groups.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

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Objective

Background

Methods

Trial design

Outcomes

Results

Follow-up and recurrence

Clinical outcomes

Conclusions

Keywords

Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Mesh Versus Nonabsorbable Mesh A Randomized Controlled Trial David I. Watson, MD, MBBS, FRACS, ∗ Sarah K. Thompson, MD, PhD, FRCSC, FRACS,† Peter G. Devitt, MS,† Lorelle Smith, BNurs, ∗† Simon D. Woods, MBBS, FRACS,‡ Ahmad Aly, MBBS, MS, FRACS,§ Susan Gan, MBBS, FRACS, ∗ Philip A. Game, MBBS, FRCS, FRACS,† and Glyn G. Jamieson, MS, MBBS, FRCS, FACS, FRACS† Objective: Determine whether absorbable or nonabsorbable mesh in repair of large hiatus hernias reduces the risk of recurrence, compared with suture repair. Background: Repair of large hiatus hernia is associated with radiological recurrence rates of up to 30%, and to improve outcomes mesh repair has been recommended. Previous trials have shown less short-term recurrence with mesh, but adverse outcomes limit mesh use. Methods: Multicentre prospective double blind randomized controlled trial of 3 methods of repair: sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome—hernia recurrence assessed by barium meal radiology and endoscopy at 6 months. Secondary outcomes—clinical symptomscores at 1, 3, 6, and 12 months. Results: A total of 126 patients enrolled: 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Among them, 96.0% were followed up to 12 months, with objective follow-up data in 92.9%. A recurrent hernia (any size) was identiﬁed in 23.1% after suture repair, 30.8% after absorbable mesh, and 12.8% after nonabsorbable mesh (P = 0.161). Clinical outcomes were similar, except less heartburn at 3 and 6 months and less bloating at 12 months with nonabsorbable mesh; more heartburn at 3 months, odynophagia at 1 month, nausea at 3 and 12 months, wheezing at 6 months; and inability to belch at 12 months after absorbable mesh. The magnitudes ofthe clinical differences were small. Conclusions: No signiﬁcant differences were seen for recurrent hiatus hernia, and the clinical differences were unlikely to be clinically signiﬁcant. Overall outcomes after sutured repair were similar to mesh repair. Keywords: hiatus hernia, laparoscopy, mesh repair, randomized controlled trial (Ann Surg 2015;261:282–289) L aparoscopic large hiatus surgery for the treatment of patients with a very hernia is now standard clinical practice. This prob- From the ∗Flinders Medical Centre, Department of Surgery, Flinders University, Bedford Park, South Australia, Australia; †Royal Adelaide Hospital, Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia;‡Cabrini Hospital, Malvern, Victoria, Australia; and §Department of Surgery, Austin Hospital, University of Melbourne, Heidelberg, Victoria, Australia. Disclosure: This randomized trial was supported by Research Project Grants from the National Health and Medical Research Council (NHMRC) of Australia (Grant numbers 375111 and 1022722) . This trial is registered with the Australia and New Zealand Clinical Trials Registry ACTRN12605000725662 . The authors declare no conﬂicts of interest. Reprints: David I. Watson, MD, MBBS, FRACS, Flinders Medical Centre, Department of Surgery, Flinders University, Room 3D211, Bedford Park, South Australia 5042, Australia. E-mail: david.watson@ﬂ[inders.edu.au](inders.edu.au). Copyright 2014 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0003-4932/14/26102-0282 DOI: 10.1097/SLA.0000000000000842 lem occurs most commonly in elderly patients, and in the early days of laparoscopic antireﬂux surgery it represented less than 10% of the antireﬂux surgery and hiatus hernia repair workload.1 However, as laparoscopic techniques for repair have become more reliable, surgeons have been referred more patients with very large hiatus hernias, and in recent years the number of patients with this problem has increased greatly, now comprising approximately 50% of the laparoscopic antireﬂux surgery workload in our practices.1 In the 1990s, the standard approach to lap

FAQs

What question did the randomized controlled trial address?

Whether absorbable or nonabsorbable mesh in repair of very large hiatus hernias reduces hernia recurrence compared with suture repair.

How was hernia recurrence assessed in the study?

Recurrence was assessed using barium meal radiology and endoscopy, with the primary evaluation at 6 months.

Were there significant differences in recurrence and symptoms between repair methods?

No significant differences were observed for recurrent hiatus hernia. Clinical symptom differences were small and unlikely to be clinically significant overall.

Aug 25, 2026

Uploaded by Xiajie