CONTEMPORARY OUTCOMES OF LAPAROSCOPIC VS. ROBOTIC GIANT PARAESOPHAGEAL HERNIA REPAIR
Taha M. Qaraqe*, Donald E. Low
General and Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA
Purpose: The incidence of symptomatic paraesophageal hernias requiring surgical therapy is increasing. Laparoscopic repair has become a well-established approach but the increased availability of robotics has provided an alternative for surgical repair. This study compares the contemporary outcomes of laparoscopic and robotic paraesophageal hernia repairs done at a single institution.
Methods: Consecutive patients who underwent elective primary laparoscopic or robotic PEH repair between January 2017 and March 2022 were included. Robotic repairs were first introduced at our institution in 2017. 153 patients (64.8±11.8yrs, 114 Female) underwent either laparoscopic (n=80, 52%) or robotic (n=73, 48%) elective primary PEH repair. Surgical groups were well matched for age, sex, BMI and ASA grade. All patients underwent standardized pre-operative evaluation (EGD, UGI, HRM) and were included in well-established post-operative ERAS protocol. All patients underwent routine symptomatic, and objective (UGI) follow up 3-6 months post-operative. Data was collected retrospectively within an IRB approved database.
Results: Patients undergoing robotic repair reported more pre-operative heartburn (97 vs. 74%) and demonstrated more esophagitis (38 vs. 10%) and Barrett's (18 vs. 3%). The percentage of intrathoracic stomach (61±16 vs. 46±15%).
Median length of surgery, conversion rate and median intraoperative blood loss were equivalent.
Length of hospital stay (2 [1-2] vs. 2 [2-3]days; P<0.001) and the pulmonary complications were greater for patients who underwent robotic surgery.
No difference was noted post-operative: Heartburn (14% vs. 22% P=0.364), Recurrent reflux (14% vs. 22% P=0.364), Recurrent hernia (14% vs. 14% P=0.680) or re-operations (3% vs. 4% P=0.050).
Conclusion: In spite of having a more complex operative population with respect to hernia size and the incidence of esophagitis and Barrett's and acknowledging the possibility of the effect of a learning curve, the outcomes of robotic paraesophageal hernia repair were overall equivalent to laparoscopic operations.
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