Does mesh augmentation of the hiatal repair with gore Bio-A® improve symptomatic outcomes in laparoscopic fundoplication?

Introduction:Laparoscopic fundoplication is performed for the management of symptomatic hiatus hernias and gastro-oesophageal reflux disease (GORD) refractory to medical therapy. We adopted the use of Gore Bio-A® for selected laparoscopic hiatus hernia repairs in 2011 and with this case series aimed to establish whether mesh augmentation affects symptomatic outcomes. Methods:A retrospective review of prospectively collected data from all laparoscopic fundoplications performed by a single surgeon between October 2011 and January 2013 was performed. Patient specific data were entered into a proforma and analysed using Microsoft Excel™. Patient reported outcomes were assessed with a system specific quality of life questionnaire (GORD-HRQL) both pre and post-operatively. Results:Twenty-three patients underwent laparoscopic fundoplication during the study period. Gore Bio-A® re-enforcement of the hiatal repair was used in 14 patients and was the preferred option for those with pre-operative evidence of a large hiatus hernia. Whilst overall there was a statistically significant difference between pre and post-operative scores (21 vs 0, p = < 0.0001, Mann-Whitney U test), there was no clear difference observed in pre-operative scores (22 vs 20, p = 0.21, Mann-Whitney U test), postoperative scores (0 vs 0, p = 0.92, Mann-Whitney U test) or symptom improvement (21 vs 20, p = 0.24, MannWhitney U test) between the mesh and non-mesh groups. Conclusions:Augmentation of the hiatal repair with biosynthetic mesh is safe, feasible and may contribute to improved symptomatic outcomes in selected cases with a large hiatus hernia. We suggest a further assessment with a larger randomised sample and long term follow-up for definitive evaluation.