Aslam Arham, Hubka Michal, Sternbach Joel, Kuppusamy Madhan
Virginia Mason Medical Center, Seattle, USA.
J Robot Surg. 2024 Dec 12;19(1):24. doi: 10.1007/s11701-024-02182-4.
Hiatal hernia (HH), or type I paraoesophageal hernias (PEH), can commonly be grouped along with types II-IV PEHs. The fundamental operation performed for repair is similar for all types. We question whether the clinical outcomes following surgical repair differ. The objective of this study is to determine the differences in clinical outcomes when comparing robotic-assisted surgical repair of HH versus types II-IV PEHs. This is a retrospective study analyzing 602 consecutive patients that underwent robotic-assisted repair of a PEH between August 2018 and June 2024. Data were retrieved from an IRB-approved database (IRB21-014). Tertiary referral center. Eligibility criteria included patients with objective findings of a PEH on diagnostic testing. 184 patients were excluded due to: emergent operation, repeat operations, conversion to open operation, patients pending follow-up, and patients lost to follow up. Patient demographics were consistent with a population-based sample. All patients underwent robotic-assisted laparoscopic PEH repair with a fundoplication using the Da Vinci Xi robotic system (Intuitive Surgical, Sunnyvale, CA). No mesh implantation was used. The primary study outcome was post-operative symptomatic improvement when comparing HH repairs versus types II-IV PEH repairs. Secondary outcomes included other perioperative outcomes. The hypothesis was formulated before data collection started. Patients in the HH cohort showed significant reflux symptom improvement postoperatively (98% vs 12.2%, p < 0.01). PEH patients also showed similar improvements in reflux symptoms (84.8% vs 25%, p < 0.01). Symptomatic improvement of dysphagia was found to be significant only in the PEH cohort (54% vs 17.8%, p < 0.01). HHs and PEHs are two distinct entities that present with different symptoms; however, the fundamental operation is similar. Symptomatic outcomes differ between the two patient populations, even with the same surgical management.
食管裂孔疝（HH），即I型食管旁疝（PEH），通常可与II-IV型PEH归为一类。所有类型的修复基本手术操作相似。我们质疑手术修复后的临床结果是否存在差异。本研究的目的是确定比较机器人辅助手术修复HH与II-IV型PEH的临床结果差异。这是一项回顾性研究，分析了2018年8月至2024年6月期间连续602例行机器人辅助PEH修复术的患者。数据从经机构审查委员会批准的数据库（IRB21-014）中检索。三级转诊中心。纳入标准包括诊断检查有PEH客观发现的患者。184例患者因以下原因被排除：急诊手术、再次手术、转为开放手术、等待随访的患者以及失访患者。患者人口统计学特征与基于人群的样本一致。所有患者均使用达芬奇Xi机器人系统（直观外科公司，加利福尼亚州桑尼维尔）进行机器人辅助腹腔镜PEH修复并加做胃底折叠术。未使用补片植入。主要研究结果是比较HH修复与II-IV型PEH修复术后症状改善情况。次要结果包括其他围手术期结果。该假设在数据收集开始前就已提出。HH队列患者术后反流症状有显著改善（98%对12.2%，p<0.01）。PEH患者反流症状也有类似改善（84.8%对25%，p<0.01）。仅在PEH队列中发现吞咽困难症状改善显著（54%对17.8%，p<0.01）。HH和PEH是表现出不同症状的两种不同实体；然而，基本手术操作相似。即使采用相同的手术管理，这两类患者的症状结果仍存在差异。
