Beyond Hernia Recurrence: Mesh Reinforcement Significantly Reduces Intrathoracic Wrap Migration after Laparoscopic Fundoplication—A Meta-Analysis of 1171 Patients

Abstract

Background:

Intrathoracic wrap migration (IWM) is a relatively infrequent but clinically significant complication following laparoscopic fundoplication (LF). This meta-analysis aimed to synthesize the available evidence comparing the incidence of IWM after primary cruroplasty with or without mesh reinforcement.

Methods:

A systematic search of PubMed, Embase, Scopus, Web of Science, and Cochrane Library was performed through February 2026. The primary outcome was the incidence of IWM following LF with mesh reinforcement versus simple suture repair. Secondary outcomes included operative time and postoperative dysphagia. The random-effects model was used to calculate the pooled odds ratios (OR) and mean difference (MD) with 95% confidence intervals (CI).

Results:

Of 507 studies screened, 7 cohort studies comprising 1171 patients were included. The mesh group represented 43.5% of patients (n = 510). Overall, 43% were female (n = 504) with a mean age of 54.3 years. There was no significant difference in age or sex distribution between groups. Mesh reinforcement during LF was associated with a significantly lower risk of IWM (OR = 0.21; 95% CI = 0.10 to 0.42; I² = 0%). Sensitivity analyses confirmed the robustness of the IWM findings across prospective studies and polypropylene mesh subgroups. There was no statistically significant difference in operative time (MD =+14.22 minutes; P = .05). Mesh reinforcement was associated with a higher risk of dysphagia at 3 months (OR = 2.22; 95% CI = 1.60 to 3.09; I² = 0%), with no significant difference observed at 1-year follow-up.

Conclusion:

Mesh reinforcement during LF was associated with a significantly lower risk of IWM compared with simple suture repair, without significant differences in operative time and long-term dysphagia.