Improved outcomes with robotic-assisted laparoscopic paraesophageal hernia repairs compared with laparoscopic and transthoracic approaches: A single high-volume institution experience.

Abstract

<h4>Objectives</h4>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.<h4>Methods</h4>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.<h4>Results</h4>Among 207 cases (52 lap, 90 robot, and 65 transthoracic), robot was lower than lap (odds ratio [OR], 0.13-0.17; <i>P</i> < .01) and similar to transthoracic (OR, 0.79-1.02; <i>P</i> > .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; <i>P</i> < .01). Robotic Sx recurrence was lower in robot compared with lap across analyses (OR, 0.40-0.50; <i>P</i> < .001). Median length of stay was 2 days for robot and lap, significantly shorter than transthoracic (median, 5 days; <i>P</i> < .01). Fewer postoperative complications occurred in robot compared with transthoracic (OR, 0.19-0.21; <i>P</i> < .01). Reoperation and endoscopic intervention were lower in robot compared with lap (OR, 0.09-0.12; <i>P</i> < .01 and OR, 0.32-0.40; <i>P</i> < .05).<h4>Conclusions</h4>Robotic paraesophageal hernia repairs had generally lower 2-year recurrence and reoperation than lap and shorter hospital stays and fewer immediate complications than transthoracic.