Meta-Analysis of Hiatal Hernia Repair: Mesh Versus Suture Techniques

Abstract

Background: Hiatal Hernia Repair (HHR) is a common surgical intervention to correct herniation of abdominal contents through the esophageal hiatus, which can lead to gastroesophageal reflux, dysphagia, and other complications. The use of mesh reinforcement versus suture-only repair remains controversial.

Objective: This meta-analysis systematically evaluates outcomes of mesh versus suture HHR, focusing on recurrence, reoperation rates, postoperative complications, and symptom resolution.

Methods: A comprehensive search was conducted in PubMed, MEDLINE, Cochrane Library, and Scopus up to September 2025. Randomized controlled trials, cohort, and case-control studies comparing mesh and suture techniques were included. Data were extracted on recurrence, reoperation, complications, and symptom resolution. Pooled Odds Ratios (ORs) were calculated using random-effects models.

Results: Twenty-five studies with 3,500 patients were included. Mesh reinforcement significantly reduced recurrence (OR 0.48, 95% CI 0.32–0.72) and reoperation rates (OR 0.58, 95% CI 0.39–0.87) compared to suture repair. Postoperative dysphagia was slightly higher with mesh, but overall complications were similar. Symptom resolution was comparable between groups. Subgroup analysis suggested biosynthetic meshes (Phasix™ ST) had the best outcomes.

Conclusions: Mesh reinforcement improves surgical outcomes in HHR, particularly in reducing recurrence and reoperation rates. Choice of mesh and patient selection are critical. Long-term studies are warranted to validate durability and safety.