Surgical strategies for recurrent hiatal hernia
HUANG En-min
HOU Ze-hui
MA Ning
CHEN Shuang
ZHOU Tai-cheng
Abstract：Recurrent hiatal hernia(HH)after initial repair remains a high recurrence rates and its reoperation requires personalized strategies integrating anatomical,technical,and patient-specific factors.Key recurrence mechanisms include collagen metabolism dysfunction,excessive suture tension,and suboptimal mesh selection,compounded by obesity,advanced age,and Barrett's esophagus.Indications for reoperation include refractory symptoms(GERD-HRQL score ≥20),large hernia volume(＞500 cm3),or acute complications(e.g.,gastric volvulus).Technical advancements such as biosynthetic mesh(e.g.,P4HB)and robotic-assisted surgery reduce recurrence rates to 4.8％,while keyhole-shaped mesh lowers recurrence risk by 50％compared to U-shaped configurations.Postoperative management emphasizes imaging surveillance(annual CT)and lifestyle modifications(weight control,smoking cessation),cutting secondary recurrence.Future innovations include smart meshes,genetic biomarkers,and AI-driven surgical planning,though multicenter trials are needed to validate long-term outcomes.
Keywords：hiatal herniarecurrent herniareoperationbio-synthetic meshrobotic-assisted surgerypersonalized therapy
Publication Date：2025-05-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：5( 509-513 )