BIO-A versus Phasix biosynthetic mesh in minimally invasive hiatal hernia repair: systematic review and meta-analysis.

Authors

Cristian A Angeramo, Juan J Baz Gallego, Emmanuel E Sadava, Fernando A M Herbella, Francisco Schlottmann

Published in

Hernia : the journal of hernias and abdominal wall surgery. Volume 30. Issue 1. Jun 15, 2026. Epub Jun 15, 2026.

Abstract

Although surgical repair is the standard treatment for symptomatic large hiatal hernias, recurrence rates remain high. Biosynthetic meshes have been designed to reinforce the crural closure while minimizing mesh-related complications. The aim of this study was to compare surgical outcomes between two widely adopted biosynthetic prostheses for hiatal hernia repair (BIO-A and Phasix).
A systematic review of literature from January 1990 to July 2025 was conducted according to PRISMA guidelines. Studies reporting outcomes of minimally invasive hiatal hernia repair (HHR) with either BIO-A or Phasix were included. Main outcomes were symptom improvement, GERD-HRQL scores, proton pump inhibitor (PPI) use, and hernia recurrence. Secondary outcomes included mesh-related complications, overall and major morbidity, reoperation, and mortality. A meta-analysis of proportions and paired t-tests were performed.
A total of 20 studies comprising 1,880 HHR procedures (BIO-A: n = 1,171 versus Phasix: n = 709) were analyzed. Mean follow-up was 26.5 and 29.6 months for BIO-A and Phasix studies, respectively. Both groups significantly improved symptoms (BIO-A: 65% to 16%, p = 0.003 vs. Phasix: 70% to 12%, p = 0.01), GERD-HRQL scores (BIO-A: 14.83 to 2.67 vs. Phasix: 18.40 to 4.40; p = 0.45), and reduced PPI use (BIO-A: 82% to 15% vs. Phasix: 84% to 10%; p = 0.75). Recurrence rates were similar between groups (BIO-A 9% vs. Phasix 7%, p = 0.63). Overall and major morbidity were also similar between groups (BIO-A: 10% and 0.7% vs. Phasix: 8% and 1.1%, respectively).
Both prostheses were associated with favorable GERD-related outcomes, low surgical morbidity, and low recurrence rates after HHR. However, these findings should be interpreted cautiously, as between-group comparisons are exploratory and based on indirect evidence.

PMID:
42295448
Bibliographic data and abstract were imported from PubMed on 15 Jun 2026.

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