Complications Following Robotic Hiatal Hernia Repair Are Higher Compared to Laparoscopy

Ward, Marc; Hasan, Syed; Sanchez, Christine; Whitfield, Edward P; Ogola, Gerald; Leeds, Steven G.

doi:10.1007/s11605-021-05005-1

Cited by 21 publications

(32 citation statements)

References 21 publications

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“…This finding persisted even when specifically analyzing high-volume centers (>20 cases per year) with an OR of 0.57. This finding is a stark contrast to what we found when doing a similar analysis for paraesophageal hernia repair 15. In that study, we found laparoscopic paraesophageal hernia repair have lower overall complications even in high-volume centers compared with robotics.…”

Section: Discussioncontrasting

confidence: 88%

“…This finding is a stark contrast to what we found when doing a similar analysis for paraesophageal hernia repair. 15 In that study, we found laparoscopic paraesophageal hernia repair have lower overall complications even in high-volume centers compared with robotics. Achalasia is much less common than paraesopahgeal hernias; therefore, Heller myotomy is performed less frequently than paraesophageal hernia repair.…”

Section: Discussionmentioning

confidence: 76%

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Overall Complications Following Robotic Heller Myotomy Are Lower Compared With Laparoscopy

Chacko

Leeds

Aladegbami

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: The use of robotics in foregut surgery has become more prevalent in the United States over the last 10 years. We sought to find the differences in the clinical outcomes of robotic surgery compared with traditional laparoscopy in patients undergoing Heller myotomy. Materials and Methods: A retrospective population-based analysis was performed using the National Inpatient Sample (NIS) database for the span of 2010 to 2015. All patients who underwent laparoscopic or robotic Heller myotomy were included. Weighted multivariable random intercept linear and logistic regression models were used to assess the impact of robotic surgery on patient outcomes compared with laparoscopy. Results: There was a total of 11,562 patients with a median age of 54.2 years. Robotic Heller myotomy has a significantly decreased risk of overall complications for all centers (odds ratio=0.46; 95% confidence interval=0.29, 0.74). A subset analysis was performed looking specifically at high-volume centers (>20 operations per year), and overall complications remained lower in the robotic group. However, in high-volume centers, the robotic cohort did have a higher rate of esophageal perforation (2.7% vs. 0.8%, P<0.001). There was a higher length of stay in the laparoscopic Heller cohort (3.0 vs. 2.6 d, P=0.06) but higher overall charges in the robotic Heller cohort ($42,900 vs. $34,300, P=0.03). Conclusions: Robotic Heller myotomy is associated with lower overall complications and improved outcomes compared with laparoscopic Heller myotomy, even in high-volume centers. Robotic Heller myotomy is associated with a higher rate of esophageal perforations in high-volume centers despite the reduction in overall complications.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 76%

Overall Complications Following Robotic Heller Myotomy Are Lower Compared With Laparoscopy

Chacko

Leeds

Aladegbami

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…Secondly there is the inherently higher cost of robotic surgery. A recent comparative retrospective series showed charge of a robotic case to be US$15-20,000 higher than for laparoscopy [89]. Thirdly and most importantly the loss of haptic feedback with the robot can lead to increased complications.…”

Section: Role Of Robotic Repairmentioning

confidence: 99%

“…Thirdly and most importantly the loss of haptic feedback with the robot can lead to increased complications. Increased risk of respiratory failure and esophageal/gastric perforations can occur as a result of poor tissue handling and tearing [89,90]. However improved design of subsequent generations of the robot, early incorporation of robotic modules into surgical training and widespread accessibility of the robot will eventually make it a better competitor to the laparoscopic technique.…”

Section: Role Of Robotic Repairmentioning

confidence: 99%

Large hiatus hernia: time for a paradigm shift?

Rajkomar

Berney

2022

BMC Surg

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Background Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. Its rarity and complexity, coupled with suboptimal initial approach that is usually best suited for small symptomatic herniae have contributed to unacceptable higher failure rates. Results We have therefore undertaken a systematic appraisal of LHH with a view to clear out our misunderstandings of this entity and to address dogmatic practices that may have contributed to poor outcomes. Conclusions First, we propose strict criteria to define nomenclature in LHH and discuss ways of subcategorising them. Next, we discuss preoperative workup strategies, paying particular attention to any relevant often atypical symptoms, indications for surgery, timing of surgery, role of surgery in the elderly and emphasizing the key role of a preoperative CT imaging in evaluating the mediastinum. Some key dissection methods are then discussed with respect to approach to the mediastinal sac, techniques to avoid/deal with pleural breach and rationale to avoid Collis gastroplasty. The issues pertaining to the repair phase are also discussed by evaluating the merits of the cruroplasty, fundoplication types and gastropexy. We end up debating the role of mesh reinforcement and assess the evidence with regards to recurrence, reoperation rate, complications, esophageal dilatation, delayed gastric emptying and mortality. Lastly, we propose a rationale for routine postoperative investigations.

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“…This approach eventually was replaced by conventional laparoscopic repair, with reduced rates of perioperative morbidity and shorter hospital stays. 2 , 3 However, there were some pitfalls to conventional laparoscopic surgery, including unstable video-camera, limited motion of straight laparoscopic instruments, and 2-D imaging. 3 , 4 More recently, robotic-assisted laparoscopic surgery has become increasingly prevalent.…”

Section: Introductionmentioning

confidence: 99%

Comparing Outcomes of Robotic-Assisted versus Conventional Laparoscopic Hiatal Hernia Repair

Tjeerdsma

Quinn

Helmer

2022

kjm

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Introduction. Robotic-assisted laparoscopic surgery for anti-reflux and hiatal hernia surgery is becoming increasingly prevalent. The purpose of this study was to compare hospital length of stay and outcomes of robotic-assisted versus conventional laparoscopic hiatal hernia repair. Methods. A retrospective review was conducted of 58 patients who underwent robotic-assisted laparoscopic (n = 42, 72.4%) or conventional laparoscopic (n = 16, 27.6%) hiatal hernia repair. Results. Patient characteristics and comorbidities were similar between groups. The robotic-assisted group had a significantly higher use of fundoplication (81.3% vs. 38.1%; p = 0.007). Complications observed between the robotic-assisted and conventional laparoscopic groups were pneumothorax (6.3% vs. 11.9%, p = 1.000), infection (0% vs. 4.8%, p = 1.000), perforation (0% vs. 2.4%, P=1.000), bleeding (6.3% vs. 2.4%, p = 0.479), ICU admission (31.3% vs. 11.9%, p = 0.119), and mechanical ventilation (18.8% vs. 2.4%, p = 0.60). There were no reported complications of dysphagia, DVT/PE, MI, or death in either group. Hospital length of stay was similar for robotic vs conventional patients (3.0 vs. 2.5 days, p = 0.301). Conclusions. This study’s data showed robotic-assisted hiatal hernia repair has comparable outcomes to conventional laparoscopic repair.

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Complications Following Robotic Hiatal Hernia Repair Are Higher Compared to Laparoscopy

Cited by 21 publications

References 21 publications

Overall Complications Following Robotic Heller Myotomy Are Lower Compared With Laparoscopy

Overall Complications Following Robotic Heller Myotomy Are Lower Compared With Laparoscopy

Large hiatus hernia: time for a paradigm shift?

Comparing Outcomes of Robotic-Assisted versus Conventional Laparoscopic Hiatal Hernia Repair

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