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

A. Bassiri¹, O. S.. Pawar¹, C. S. Boutros², B. Jiang³, J. Sinopoli⁴, L. Tapias⁵, P. Linden¹, C. Towe^6
1University Hospitals Cleveland Medical Center, Cleveland, Ohio ²University Hospitals Cleveland Medical Center/ Case Western Reserve University, University Heights, Ohio ³University Hospitals Cleveland Medical Center, Strongsville, Ohio ⁴University Hospital Cleveland Medical Center, University Heights, Ohio ⁵University Hospitals Cleveland Medical Center, Shaker Heights, Ohio ⁶University Hospital Cleveland Medical Center, Division of Thoracic Su, Cleveland, Ohio

Purpose: Optimal surgical technique in hiatal hernia repair is undefined, especially in long term outcomes. The purpose of this study is to evaluate surgical outcomes of robotic-assisted hiatal hernia surgery compared to the traditional laparoscopic approach. We hypothesize the robotic approach will have superior surgical outcomes compared to the laparoscopic approach.

Methods: This is a retrospective study of the Society of Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD). Patients were included if they underwent minimally invasive (Robotic or Laparoscopic) hiatal hernia repair between 2018 and 2021. Patients were excluded if missing critical data variables. Primary outcomes of interest were symptom recurrence, radiographic recurrence, endoscopic intervention, and reoperation. Secondary outcomes were postoperative events, invasive procedures, 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 to assess long-term outcomes. Demographic and clinical characteristics were compared using univariate analysis. Adjusted multivariate logistic regressions were performed to evaluate short- and long-term outcomes. Data is shown as odds ratio (OR) and 95% confidence interval (CI).

Results: A total of 8,019 patients were identified that underwent minimally invasive hiatal hernia repair (laparoscopic: 5,051 [64.0%]; Robotic 2,968 [37.0%]. Figure). In multivariate models, postoperative events (OR 0.84, CI 0.67-1.06), invasive procedure (OR 0.95, CI 0.67-1.34), respiratory failure (OR 0.59, CI 0.26-1.33), and 30-day readmission (OR 1.03, CI 0.82-1.28) were similar between the two groups. Robotic hiatal hernia repair was associated with lower postoperative ileus (OR 0.59, CI 0.25-0.94) and postoperative ICU visit (OR 0.31, CI 0.13-0.75) compared to laparoscopic approach. Analysis of 1-month primary outcomes demonstrated similar symptom recurrence (OR 1.10, CI 0.88-1.37), radiographic recurrence (OR 1.44, CI 0.76-2.71), endoscopic intervention rate (OR 0.90, CI 0.60-1.37), and reoperation rate (OR 1.06, CI 0.62-1.81) between the two surgical approaches.
A subgroup of 4,549 patients were identified that underwent minimally invasive hiatal hernia repair with available 1-year follow up outcomes (laparoscopic: 2,837 [63.4%]; Robotic 1,712 [37.6%]. Figure). In multivariate modelling (Table), robotic approach was associated with lower 1-year symptom recurrence (OR 0.54, CI 0.41-0.70) and 1-year endoscopic intervention rate (OR 0.47, CI 0.34-0.67). Of note, both approaches had similar 1-year radiographic recurrence (OR 1.29, CI 0.82-2.03) and reoperation (OR 0.91, CI 0.44-1.90).

Conclusion: In the STS-GTSD, robotic hiatal hernia repair is associated with reduced postoperative ileus, ICU visits, and 1-year symptom recurrence and endoscopic intervention. While acute endpoints were similar, the findings suggest potential long-term benefits of the robotic approach. Further studies are needed to substantiate these findings and account for unmeasured variables.

Identify the source of the funding for this research project: The work was supported by the Intuitive Foundation – Clinical Research Grant. Funding was used for purchases Database access