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Bitner et al. Mini-invasive Surg 2022;6:46 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.46

Editorial Open Access

Mesh or no mesh in anti-reflux surgery

Daniel P. Bitner 1 , Filippo Filicori 1,2
1
Intraoperative Performance Analytics Laboratory (IPAL), Department of Surgery, Lenox Hill Hospital, New York, NY 10021, USA.
2
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA.
Correspondence to: Dr. Daniel Bitner, Intraoperative Performance Analytics Laboratory (IPAL), Department of Surgery, Lenox
Hill Hospital, 186 E 76th Street, New York, NY 10021, USA. E-mail: DBitner@northwell.edu
How to cite this article: Bitner DP, Filicori F. Mesh or no mesh in anti-reflux surgery. Mini-invasive Surg 2022;6:46.
https://dx.doi.org/10.20517/2574-1225.2022.46
Received: 9 May 2021 Accepted: 1 Jun 2022 Published: 1 Aug 2022

Academic Editor: Fernando A. M. Herbella Copy Editor: Jia-Xin Zhang Production Editor: Jia-Xin Zhang

INTRODUCTION & BACKGROUND
History of evidence accumulation for anti-reflux surgery
Surgery against refractory gastroesophageal reflux disease and hiatal hernia depends on hiatal closure and
prevention of either recurrent herniation or symptoms of ongoing reflux . In the past few decades in anti-
[1]
reflux surgery (ARS), attempts have been made to judge the quality of the evidence underlying the practices
of surgeons in ARS. In the second half of the twentieth century, the evidence base for many practices in ARS
[1]
was poor . One suggestion to augment hiatal closure was the use of mesh, but its use was supported by
mostly case series and reports until the turn of the century. Currently, the use of mesh is not universally
accepted, and more studies have accumulated about the use of mesh in ARS .
[2,3]
Trends of mesh use in ARS
In a 2010 survey of members of the Society of American Gastrointestinal and Endoscopic Surgeons
(SAGES), mesh was commonly used in hiatal hernia repair (HHR) and the most commonly cited indication
(45% of respondents) for mesh placement was the size of the hernia defect with 24% citing a size of 5 cm as
[4]
the decision point . The technique of placement was highly heterogeneous although an onlay technique in
some fashion and suture fixation were most common . In a similar survey of SAGES members in 2012, 77%
[4]
of respondents at least selectively used mesh in HHR with the trend in the data suggesting that younger
surgeons were more likely to use mesh than were older surgeons . In both surveys of the SAGES
[5]
[4,5]
community, mesh types were heterogeneous although biologic meshes were most commonly used .
Similar results were found in a survey of the European Association for Endoscopic Surgery (EAES) in 2015,

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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