Dual-sided composite mesh repair of hiatal hernia: Our experience and a review of the Chinese literature

Table 1 Classification of hiatal hernia

Type	Description
I	Sliding hernia with the GEJ above the diaphragm
II	Paraesophageal hiatus hernia. A part of the stomach herniates through the hiatus and lies beside the esophagus, without movement of the GEJ
III	Combined hernia. The combination of type I and II
IV	A large defect in the hiatus, allowing other organs to enter the hernia sac

GEJ: Gastroesophageal junction.

Table 2 Baseline characteristics of the patients who underwent laparoscopic antireflux surgery

Item	Value
Age (yr)	53.81 ± 13.76 (21-75)
Body mass index (kg/m2)	28.95 ± 3.11 (21-35)
Hiatal hernia length (cm)	4.33 ± 0.84 (3.1-6.3)
Hiatal hernia width (cm)	2.85 ± 0.85 (1.8-5.4)
DeMeester score	50.30 ± 27.73 (12.7-112.7)
Surgery duration (min)	119.29 ± 23.84 (80-175)
Postoperative stay (d)	4.71 ± 0.85 (4-7)

Data are expressed as absolute mean ± SD (range).

Table 3 Symptom evaluation before and after surgery

	Before surgery	After surgery	P value
Heartburn	5.33 ± 1.65	2.14 ± 1.74	0
Regurgitation	5.00 ± 1.64	1.95 ± 1.16	0
Chest pain	3.62 ± 1.99	1.29 ± 1.15	0
Dysphagia	2.57 ± 1.66	1.62 ± 1.86	0.087
Abdominal pain	2.33 ± 1.28	1.38 ± 1.12	0.014

Table 4 Chinese literature on the use of dual-sided mesh for hiatal hernia repair

Author	Patients	Hernia size	Hiatorrhaphy	Antireflux surgery	Follow-up (mo)	Recurrence rate	Complications
Chu et al[13]	12	III (8), IV (4)	Yes	Nissen	12-60	0/12	-
Wang et al[14]	15	I (6), II (7), III (2)	Yes	Toupet	Median 18	0/15	1 dysphagia, 2 PPI treatment
Tai et al[15]	21	I (9), II (4), III (6), IV (2)	Yes	Toupet	1-16	0/21	3 dysphagia
Ji et al[16]	7	-	Yes	Nissen	6-24	0/7	-
Ma et al[17]	40	I 1 (3), II (4), III (15), IV (8)	Yes	Toupet/Dor	3-25	0/40	6 dysphagia
Zhao et al[18]	25	All > 6 cm	Yes	Nissen/Toupet/Dor	3-35	1 (1)/251	6 dysphagia, 1 PPI treatment
Xu et al[19]	3	13-18 cm	Yes	Toupet	6-12	0/3	-
Zhang et al[20]	21	I 1 (4), II (5), III(2)	Yes	Toupet	6-36	0/21	-
Zou et al[21]	20	All > 6 cm	Yes	Dor	> 12	2 (5)/201	-
Yao et al[22]	33	I (5), II (23), III(5)	Yes	Nissen	> 12	1 (10)/331	3 dysphagia, 1 gastric retention
Li et al[23]	4	-	Yes	Nissen/Toupet	1-36	0/4	-
Fei et al[24]	12	< 5 cm (10), > 5 cm (2)	Yes	Nissen	12	0/12	1 dysphagia

¹Anatomic recurrence (symptomatic recurrence)/total patient number. PPI: Proton pump inhibitor.