Evidence map›Paper›PMID 40629013›Full record

SynthesisSurgical endoscopy2025

Evaluating surgical outcomes of hiatal hernia repair techniques with and without fundoplication: a network meta-analysis.

Brett P Weiss, Sameh Hany Emile, Nir Horesh, Justin Dourado, Anjelli Wignakumar, Victoria De Trolio, Mohamed Moola, Michelle Hambleton, Raul Rosenthal, Emanuele Lo Menzo

Erratum issuedAbstract readNetwork Meta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Efficacy and safety of mesh reinforced cruroplasty with Phasix™ ST vs. Bio-AHernia : the journal of hernias and abdominal wall surgery · 2026
    Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Brett P WeissDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Sameh Hany EmileDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Nir HoreshDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Justin DouradoEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Anjelli WignakumarEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA.
Victoria De TrolioAmerican University of the Caribbean, Cupecoy, St. Maarten.
Mohamed MoolaDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Michelle HambletonDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Raul RosenthalDivision Chief, General Surgery, Department of Surgery, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine, CA, Los Angeles, USA. raulrosenthal11@gmail.com.ORCID http://orcid.org/0000-0002-7663-2464
Emanuele Lo MenzoDepartment of General Surgery and the Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThis network meta-analysis evaluated the effectiveness of different hiatal hernia repair techniques-primary repair, absorbable mesh, or non-absorbable mesh-on recurrence, postoperative dysphagia, complications, and reoperation. We hypothesized that mesh reinforcement may reduce recurrence but increase complications, and that fundoplication may reduce recurrence but increase dysphagia.

methodsA systematic search of PubMed and Scopus identified randomized controlled trials (RCTs) comparing laparoscopic hiatal hernia repair with and without mesh. The primary outcome was recurrence, with secondary outcomes including dysphagia, complications, and reoperation. Frequentist network meta-analysis was performed using the netmeta package in EZR. Results were reported using network maps, rankograms with p scores, league tables, and forest plots to compare interventions. Transitivity, risk of bias (Risk of Bias 2 tool), and confidence in evidence (CINeMA) were also assessed.

resultsNine RCTs (4 multicenter) from 2002 to 2020, including 815 patients (73% female, median age 60-67.5 years), were analyzed. 361 patients underwent primary repair, and 454 underwent mesh repair (98 absorbable and 356 non-absorbable). Most patients had concomitant fundoplication. Recurrence was reported in 157 (19.3) patients, with rates of 21.3% for primary repair and 17.6% for mesh repair (34.7% absorbable, 12.9% non-absorbable). Network meta-analyses revealed no significant differences between repair techniques. Rankograms indicated that non-absorbable mesh with fundoplication had the lowest recurrence (p score = 0.764) and dysphagia (p score = 0.727), absorbable mesh had the lowest complications (p score = 0.9285), and non-absorbable mesh without fundoplication had the lowest reoperation rates (p score = 0.889). Confidence in evidence for all outcomes was very low.

conclusionsNon-absorbable mesh with fundoplication may reduce recurrence and dysphagia, while absorbable mesh is associated with fewer complications. No significant differences between primary repair and mesh reinforcement were observed. Further RCTs with long-term follow-up are needed.

Indexed as

FundoplicationHernia, HiatalHerniorrhaphyLaparoscopyDeglutition DisordersHumansPostoperative ComplicationsRandomized Controlled Trials as TopicRecurrenceReoperationSurgical MeshTreatment OutcomeAbsorbable meshComplicationsDysphagiaFundoplicationHiatal herniaMeshMeta-analysisNetwork meta-analysisNon-absorbable meshPrimary repairRecurrenceReoperation

Identifiers

PMID40629013

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.