Robotic surgery for giant paraesophageal hernias: a promising approach to improved outcomes

Giant paraesophageal hernias (GPEH) present challenges in management and surgical technique. Laparoscopic repair has been the gold standard for GPEH repair. Despite technical advances in laparoscopy, complications and recurrence remain high. The da Vinci Surgical System has emerged as a way to improve upon the gold standard. The objective of this study is to evaluate clinical outcomes of patients who underwent robotic GPEH repair in comparison to the clinical data in the literature on laparoscopic GPEH repair. We retrospectively reviewed patient records who underwent GPEH repair between November 2012 and February 2023 at a single high-volume tertiary care center. Perioperative data and patient outcomes were collected from a prospectively maintained database. Ninety-two patients underwent robotic GPEH repair. Sixty-seven had Type III hernias (72.8%) and twenty-five had Type IV hernias (27.2%). Four (4.3%) required conversion to open repair and two (2.2%) required reoperation for recurrence. Twelve (13.0%) experienced complications including one surgical complication (splenic laceration) and eleven medical complications (fever, ileus, pleural effusion, and heart failure exacerbation). There was no perioperative mortality. Mean operative time was 166.4 ± 29.5 min, and hospital stay was 5.8 ± 3.1 days. Obesity (BMI > 30) was associated with higher complication and recurrence rates. Robotic GPEH repair demonstrates promising outcomes, with lower recurrence rates and fewer postoperative complications compared to published data on laparoscopic repair. While a randomized control trial is needed to substantiate these results, our data support that a robotic approach could become the standard of care for GPEH repair.