Robotic Fundoplication for Large Paraesophageal Hiatal Hernias

Abstract

Purpose: Laparoscopic fundoplication is now a cornerstone in the treatment of gastro-esophageal reflux disease (GERD) with sliding hernia. The best outcomes are achieved in those patients who have some response to medical treatment compared to those who do not. Robotic fundoplication is considered a novel approach in treating GERD with large paraesophageal hiatal hernias. Our goal was to examine the feasibility of this technique. Methods: Seventy patients (23 males and 47 females) with mean age 64 y old (22-92), preoperatively diagnosed with a large paraesophageal hiatal hernia, were treated with a robotic approach. Biosynthetic tissue absorbable mesh was applied for hiatal closure reinforcement. Fifty-eight patients underwent total fundoplication, 11 patients had partial fundoplication, and one patient had a Collis-Nissen fundoplication for acquired short esophagus. Results: All procedures were completed robotically, without laparoscopic or open conversion. Mean operative time was 223 min (180-360). Mean length of stay was 38 h (24-96). Median follow-up was 29 mo (7-51). Moderate postoperative dysphagia was noted in eight patients, all of which resolved after 3 mo without esophageal dilation. No mesh-related complications were detected. There were six hernia recurrences. Four patients were treated with redo-robotic fundoplication, and two were treated medically. Conclusions: The success of robotic fundoplication depends on adhering to a few important technical principles. In our experience, the robotic surgical treatment of gastroesophageal reflux disease with large paraesophageal hernias may afford the surgeon increased dexterity and is feasible with comparable outcomes compared with traditional laparoscopic approaches.

Gastric Outlet Obstruction Caused by Acute Gastric Volvulus: A Rare Complication of Hiatal Hernia

“…Modern surgical treatment of hiatal hernias can be done laparoscopically with robotic assistance. Robotic assistance allows for comparable outcomes to non-robotic surgeries, however, surgeons have increased ease and dexterity which can result in a longer-lasting correction [ 7 ]. Our patient was treated with a robot-assisted Nissen fundoplication that helped not only to reduce the risk of recurrent volvulus but also aided in reducing her GERD symptoms.…”

Robotic-assisted versus laparoscopic paraesophageal hernia repair: a systematic review and meta-analysis

“…Experience from robotic redo hiatal hernia repair after primary robotic procedure is provided by Arcerito et al [ 17 ], who mentioned the increased possibility of conversion to open approach due to the severe scar tissue lying between hiatal crura and fundoplication, which developed more likely from the placement of an absorbable mesh. However, no mesh-related complications are mentioned during a two-and-a-half-year time period [ 17 ], thanks to the absorbable property, even in longer follow-up periods [ 18 ].…”

Intraesophageal Migration of a Paraesophageal Hernia Mesh: A Case Report

“…However, these advantages were offset by more dysphagia [ 11 ], which is why most experts recommend mesh use only in specific circumstances [ 14 ]. Finally, robotic surgery may eventually make it easier, compared to the laparoscopic approach, when reoperating a patient like ours, considering the higher dexterity it offers [ 15 ], but its practical use remains limited because of its cost, especially in a country like ours.…”