Improved outcomes with robotic-assisted laparoscopic paraesophageal hernia repairs compared with laparoscopic and...

Laparoscopic (lap) paraesophageal hernia repair has excellent short-term outcomes but higher long-term recurrence rates compared with the transthoracic repair. We hypothesized that the robotic-assisted lap (robot) approach would have similarly good short-term outcomes as lap, but also lower recurrence rates.

A retrospective study of prospectively collected data was performed for paraesophageal hernia repairs at a single high-volume quaternary hospital from July 2018 to September 2022. Outcomes analyzed included 2-year postoperative radiographic recurrence (Rad), Society of Thoracic Surgeons-defined radiographic recurrence (STS-rad), symptomatic recurrence (Sx), and perioperative outcomes. Lap, robot, and transthoracic groups were compared using univariate, multivariate, and propensity score analysis.

Among 207 cases (52 lap, 90 robot, and 65 transthoracic), robot was lower than lap (odds ratio [OR], 0.13-0.17; P < .01) and similar to transthoracic (OR, 0.79-1.02; P > .05) in univariate and multivariate analyses. STS-rad was similar between approaches across analyses, apart from robot being higher than transthoracic on propensity score analysis (OR, 1.83; P < .01). Robotic Sx recurrence was lower in robot compared with lap across analyses (OR, 0.40-0.50; P < .001). Median length of stay was 2 days for robot and lap, significantly shorter than transthoracic (median, 5 days; P < .01). Fewer postoperative complications occurred in robot compared with transthoracic (OR, 0.19-0.21; P < .01). Reoperation and endoscopic intervention were lower in robot compared with lap (OR, 0.09-0.12; P < .01 and OR, 0.32-0.40; P < .05).

Robotic paraesophageal hernia repairs had generally lower 2-year recurrence and reoperation than lap and shorter hospital stays and fewer immediate complications than transthoracic.