Robotic Transhiatal Revision of Gastric Conduit After Esophagectomy: Experience in 15 Patients

The literature offers limited guidance on revision strategies for gastric conduit dysfunction after esophagectomy, traditionally approached through open or combined thoracoscopic-laparoscopic methods. We present our institution's early experience with robot-assisted transhiatal revisional surgery for severe conduit dysfunction.

A retrospective, single-institution review was conducted of patients who underwent robot-assisted transhiatal revision of the gastric conduit after esophagectomy between January 1999 and April 2024.

We identified 15 patients (mean age, 64.1 years). All had redundant conduit anatomy, with or without angulation or a supradiaphragmatic shelf; dysphagia was the primary symptom. Paraconduit hernia was present in 6 patients (40%). The median time from the index esophagectomy to revision was 62 months. Median hospital stay was 3 days. Two patients (13.3%) experienced perioperative complications: 1 port-site hernia and 1 pneumonia and pulmonary embolism requiring reintubation and anticoagulation. One patient required redo revision for reherniation due to vigorous coughing. One patient died of sudden death at home after an unremarkable 4-day postoperative course. At a median follow-up of 5.3 months, the 14 surviving patients reported at least partial symptom resolution and were no longer dependent on supplemental feeding.

Robot-assisted transhiatal revision of gastric conduit dysfunction after esophagectomy is feasible and safe, offering shorter hospital stays and acceptable perioperative morbidity. Although complete symptom resolution remains difficult to achieve, most patients experienced meaningful improvement in swallowing and nutritional independence. Further studies are warranted to improve outcomes in this complex patient population.