# Comparative Analysis of Hiatal Hernia Repair Techniques: A Meta-Analysis Review Study on Biological Mesh, Phasix™ Mesh, and Primary Repair

## TL;DR

This study compares different hiatal hernia repair techniques and finds that Phasix™ ST mesh has the lowest recurrence and complication rates.

## Contribution

The study provides a meta-analysis comparing Phasix™ ST mesh, biological mesh, and primary repair for hiatal hernia repair.

## Key findings

- Phasix™ ST mesh had the lowest recurrence rate compared to biological mesh and primary repair.
- No reoperations were reported with Phasix™ ST mesh.
- Postoperative dysphagia was lowest with Phasix™ ST mesh.

## Abstract

Mesh usage in hiatal hernia repair is debated regarding recurrence rates and complications. This study aims to compare the efficacy of Phasix™ ST mesh, biological mesh, and primary repair in terms of recurrence rates, reoperation rates, and mesh-related complications. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to search literature in PubMed, Embase, and Web of Science from January 2011 to November 2023. Included studies focused on participants aged 18+ undergoing hiatal hernia repair with specific mesh types or repair methods. Data on recurrence rates, reoperation rates, and mesh-related complications were analyzed by BMI and follow-up time subgroups. Statistical analysis used the Mantel-Haenszel random-effects model. Bias in studies was assessed using the ROBINS-I and Cochrane risk of bias tools for non-randomized and randomized trials. Twenty-two studies involving 2,008 patients were included. A double-arm meta-analysis comparing biological mesh and suture cruroplasty found no significant difference in recurrence or reoperation rates. The randomized trial showed no significant difference in recurrence (OR 2.02; 95% CI 0.71-5.76) or reoperation (OR 0.71; 95% CI 0.17-2.96). Non-randomized studies also showed no significant difference in recurrence (OR 0.32; 95% CI 0.03-3.06) or reoperation (OR 0.35; 95% CI 0.05-2.37). In single-arm meta-analyses, Phasix™ ST mesh had the lowest recurrence rate, followed by biological mesh and suture cruroplasty. No reoperations were reported with Phasix™ ST mesh. Postoperative dysphagia was lowest with Phasix™ ST mesh. In conclusion, Phasix™ ST mesh showed the lowest recurrence, reoperation rates, and dysphagia compared to biological mesh and primary repair, making it a preferred option.