Mesh Reinforcement in Laparoscopic Hiatal Hernia Repair: A Systematic Review and Meta-analysis of Recurrence and Complications

This systematic review and meta-analysis of randomized controlled trials aims to verify if the usage of mesh in hiatal hernia repair is superior to primary repair regarding recurrence,complications and reoperation. Recurrence rates, reoperation,bleeding,perforation and pneumothorax were the factors studied. For the systematic literature review, conducted according to the PICO framework, prospective randomized controlled trials (RCTs) published between 2000 and 2025 comparing suture-only crural repair with mesh-reinforced crural repair in patients undergoing Nissen or Toupet fundoplication for hiatal hernia were included.The certainty of evidence for the primary outcome was evaluated using the GRADE framework and categorized as high, moderate, low, or very low based on risk of bias, inconsistency, indirectness, imprecision, and publication bias.Prespecified subgroup analyses were conducted to explore potential sources of heterogeneity. In particular, subgroup analyses evaluated differences according to operative technique, specifically restoration of the crural anatomy prior to mesh placement versus tension-free approximation of the crura. Sensitivity analyses were performed by restricting the analysis to studies assessed as having low or moderate risk of bias to examine the robustness of the pooled estimates.