Expert consensus on material selection and operative methods for laparoscopic hiatal hernia repair.
10.3760/cma.j.cn441530-20250715-00268
- Collective Name:Youth Committee of the GERD Specialty Group, Surgical Branch of the Chinese Medical Doctor Association;Professional Committee of Gastrointestinal Hernia and Abdominal Wall Co-established by Guangdong Association for the Promotion of Scientific and Technological Achievement Transformation and Guangdong Institute of National Grand Health Development;Hiatal Hernia and GERD Specialty Group, Hernia and Abdominal Wall Surgery Branch of the Guangdong Medical Doctor Association
- Publication Type:Consensus Development Conference
- MeSH:
Humans;
Hernia, Hiatal/surgery*;
Laparoscopy/methods*;
Surgical Mesh;
Herniorrhaphy/methods*
- From:
Chinese Journal of Gastrointestinal Surgery
2025;28(10):1087-1095
- CountryChina
- Language:Chinese
-
Abstract:
The incidence of hiatal hernia is on the rise due to population aging and improved awareness of the disease. Laparoscopic repair is the main treatment modality; however, there remains a lack of consensus on the selection of mesh materials and operative specifications. Based on high-level evidence, this expert consensus has formulated 11 recommendations regarding the indications for mesh application, material selection, and operative methods: For patients with giant hiatal hernias (defect area >10 cm², hiatal diameter ≥ 5 cm, or over 1/3 of the gastric body entering the thoracic cavity), complex hernias, recurrent hernias, or those with weak diaphragmatic crura, mesh-reinforced repair is recommended to reduce the risk of recurrence. Synthetic meshes are suitable for giant/complex hernias; biological meshes help reduce foreign body reactions; and bioabsorbable synthetic meshes combine mechanical strength with safety. The preferred shape of the mesh is U-shaped, and fixation methods (non-absorbable sutures, absorbable staplers, or medical adhesives) are selected based on hernia size and anatomical features. For suturing the diaphragmatic crura, non-absorbable sutures are recommended, with the choice between interrupted or continuous suturing techniques tailored to patient characteristics. The method of fundoplication is determined according to esophageal pH measurement and lower esophageal sphincter pressure, and non-absorbable sutures are recommended for plication.
