Background:

Recurrence after giant hiatal hernia repair remains a major challenge.

Biologic meshes aim to reduce recurrence while avoiding synthetic mesh-related complications.

Bovine dura mater has not been previously evaluated in adult hiatal hernia repair.

This study compares bovine dura mater reinforcement vs primary crural closure.

Methods: 

Retrospective cohort (2021–2025), Clínica El Rosario.

Adults (≥18 years) undergoing laparoscopic repair of giant hiatal hernia.

Two groups:

Bovine dura mater mesh reinforcement

Primary closure without mesh

Outcomes: clinical success, complications, recurrence, reintervention, mortality.

Complementary historical comparison (Clínica SOMA, 2019–2021).

Results:

El Rosario cohort (n = 65)

Mesh group: 20 patients

No mesh group: 45 patients

? Clinical success

Mesh: 95.0% (19/20)

No mesh: 86.7% (39/45)

RR 1.19 (95% CI 1.00–1.41)

? Postoperative complications

Mesh: 5.0%

No mesh: 8.9%

? Clinical recurrence

Mesh: 15.0%

No mesh: 13.3%

? Mortality

0% in both groups

Historical SOMA series (n = 16, bovine dura mater):

Clinical success: 93.8%

Clinical recurrence: 0%

Mortality: 0%

 

Conclusions 

Bovine dura mater reinforcement showed higher clinical success without increased morbidity.

Recurrence rates remain uncertain due to sample size and follow-up duration.

Findings support safety and feasibility, warranting multicenter validation.