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Invited Critique
December 1, 2004

Mesh in the Hiatus—Invited Critique

Arch Surg. 2004;139(12):1296. doi:10.1001/archsurg.139.12.1296

This review article by Targarona et al is a meta-analysis of reports using mesh in complex paraesophageal and mixed hiatal hernias, with recurrence being the end point. Therein lies my first concern with this article. This complex disorder is more than recurrences and mesh erosion. A review article should cover all important parameters, which, in this case, include postoperative dysphagia (10%), gas bloating (8%), patient satisfaction, nausea, early satiety, and the recurrence of symptoms absent recurrent hernia, since half of these patients have resumed taking antireflux medications within 3 to 5 years after surgery. I am also troubled by 2 other observations: first, the authors do not present any data from their own experience, and second, none of the 4 coauthors is credited with a single publication in the 112 citations in the bibliography. I personally feel that credibility is an issue with review articles, because the reader infers some measure of expertise by the authors.

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