Robotic vs Laparoscopic Hiatal Hernia Repair: A Comparative Study of Short- and Long-Term Surgical Outcomes.

BACKGROUND

The purpose of this study was to evaluate the short- and long-term outcomes of minimally invasive hiatal hernia repair (HHR). We hypothesized that the robotic approach will have superior surgical outcomes compared with the laparoscopic approach.

METHODS

This is a retrospective study of patients who underwent minimally invasive HHR in The Society of Thoracic Surgeons General Thoracic Surgery Database between 2018 and 2021. Primary outcomes of interest were symptom recurrence, radiographic recurrence, endoscopic intervention, and reoperation. Secondary outcomes were postoperative events, invasive procedures, intensive care unit (ICU) visit, respiratory failure, ileus, and 30-day hospital readmission. Primary outcomes were assessed at 1 month and in a subgroup of patients with available 1-year follow-up data. Unmatched and matched (1:1 nearest neighbor propensity score matching) multivariable logistic regressions were performed to evaluate short- and long-term outcomes.

RESULTS

In 8019 patients, robotic repair was associated with lower postoperative ileus (odds ratio [OR], 0.59; CI, 0.25-0.94) and fewer ICU visits (OR, 0.31; CI, 0.13-0.75) compared with laparoscopic repair. One-month outcomes showed similar rates of symptom recurrence, radiographic recurrence, endoscopic intervention, and reoperation between the approaches. In a subgroup of 4549 patients with 1-year follow-up data, the robotic approach was associated with lower 1-year symptom recurrence (OR, 0.54; CI, 0.41-0.70) and 1-year endoscopic intervention rates (OR, 0.47; CI, 0.34-0.67).

CONCLUSIONS

Robotic hiatal hernia surgery was associated with superior outcomes in reducing postoperative ileus, ICU visits, and 1-year symptom recurrence and endoscopic intervention compared with the laparoscopic approach, suggesting its superiority in minimally invasive HHR.