Long-term Outcomes of Cruroplasty Reinforcement with Composite Versus Biologic Mesh for Gastroesophageal Reflux Disease

Aim: The aim of this study was to evaluate the issue of improvement of disadvantages of different type meshes.

Methods: A retrospective analysis was performed on 101 gastroesophageal reflux disease patients who underwent reinforcement of crura with or without prosthetic mesh. Three types of mesh, 4-ply biologic small intestine submucosa (SIS, Surgisis(®), since November 2010), 6-ply SIS (Biodesign™ Surgisis(®), since March 2011), and composite synthetic mesh (Crurasoft(®), since May 2010), were used. All patients were assigned to simple suture group (n = 35), 4-ply SIS group (n = 13), 6-ply Biodesign™ group (n = 26) or Crurasoft(®) group (n = 27). Postoperative follow-up was performed via clinical visit or phone call contact. Subjective assessment included dysphagia, patients' symptomatic outcome judgment according to Visick and patients' satisfaction. Objective evaluation included hiatal hernia recurrence according to upper endoscopy and barium contrast swallow. Follow-up was completed in 83 patients with a mean duration of 45 months (range 16-149 months).

Results: For the objective outcomes, although anatomic recurrence of hiatal hernia did not significantly differ between groups at 6 months postoperatively, long-term results showed a protective effect of mesh implantation on hernia recurrence (p = 0.047). For the subjective outcomes, the mesh group had a more significant improvement in Visick score (p = 0.020) compared to the simple suture group. Patient satisfaction was significantly higher in the mesh group (p = 0.014), and subgroup analysis showed a clear trend as follows: Crurasoft(®) ≈ Biodesign(®) > SIS(®). A higher frequency of postoperative dysphagia was presented in the Crurasoft group compared with other two groups at 6 months postoperatively, but the difference was not significant over time (p = 0.227).

Conclusion: Mesh cruroplasty results in satisfactory symptom control with a low recurrence rate. 6-ply biologic mesh is promising with respect to the reduction in anatomic recurrences. Postoperative dysphagia does not occur commonly following mesh cruroplasty with PTFE/ePTFE mesh.