382. TEN-YEAR FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL—LAPAROSCOPIC REPAIR OF LARGE HIATUS HERNIA WITH SUTURES VERSUS ABSORBABLE VERSUS NONABSORBABLE MESH

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Abstract Background Recurrence after large hiatus hernia repair has been reported as high as 55%. A mesh reinforced repair is thought reduce risk of recurrence and therefore improve clinical outcomes. Early and medium-term outcomes from our randomized control trial showed no differences between suture-only, absorbable mesh and non-absorbable mesh repair. This study aims to extend follow-up to a minimum of 10 years. Methods A multicentre prospective double-blind randomised control trial was performed comparing 3 different repair techniques for large hiatus hernias; suture-only versus absorbable mesh versus non-absorbable mesh. Hernia recurrence was assessed by routine barium X-ray or endoscopy at 3–4 years. Clinical symptom and quality of life questionnaires were sent to patients with at least 10-year follow-up. Results 126 patients were enrolled in the original study—43 suture-only, 41 absorbable mesh, and 42 non-absorbable mesh. As previously reported, at 5-year follow up, a recurrent hernia (of any size) was identified in 39.3% of suture-only repair, 56.7% -absorbable mesh, and 42.9%—non-absorbable mesh. Symptom outcomes were available at long-term follow-up (mean 14.6 years) for 45.1% of patients. There were no differences in symptoms between repair techniques. There was a significant improvement across the entire cohort in heartburn and regurgitation severity scores compared to preoperative state as well as quality of life outcomes. Conclusion Surgical repair of large hiatus hernias provides an effective and sustained treatment option for patients. We found no advantages for mesh repair beyond 10 year follow-up. The long-term outcomes for this study do not support mesh repair for large hiatus hernias.

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