Laura Bernstein, MD, Ealaf Shemmeri, MD, George DeNoto, MD, Larry Gellman, MD, Dominick Gadaleta, MD. North Shore University Hospital
Laparoscopic repair of hiatal and/or paraesophageal hernias is the standard method of treatment in most modern institutions. While the laparoscopic method has proven to have several important advantages over the open method, including decreased morbidity and mortality, less pain postoperatively, and shorter recovery time, recurrence rates after laparoscopic repair have been disappointing. The surgical robot has become more widely available and is being used to perform a wide range of surgical procedures; however, studies describing its use in the repair of hiatal hernias are still very limited. The goal of this study is to evaluate the results of robot-assisted hiatal hernia repair from our institution in order to see if using the surgical robot for these complex operations can help to improve recurrence rates.
Methods and Procedures
A retrospective review of the medical records of patients who underwent operative hiatal hernia repairs at North Shore University Hospital (NSUH) between January 2008 and June 2013 was performed. Exclusion criteria included: thoracic repair, abdominal open repair, and combined hiatal hernia with other surgeries (i.e., cholecystectomy, laparoscopic gastric band placement). Demographic information was recorded, including: age, gender, length of operation, hospital length of stay, medical and surgical history, BMI, and recurrence of hernia. Subgroup analysis will examine the role of mesh repair, fundoplication and gastropexy and how they impact recurrence in both groups. This study is approved by the investigational review board of NSUH.
A total of 197 patients had hiatal hernia repair at NSUH. Fifty-nine patients had either open, thoracic, or combined hiatal hernia repairs and therefore excluded from this analysis. One-hundred thirty eight patients were included in this review, 58 were performed robotically and 80 laparoscopically. The median age was 67 and 68 years for the robotic and laparoscopic groups, respectively. Sixty-nine percent of the robotic group and 75% of the laparoscopic groups were female, respectively. Only one-third of the robotic cases were performed with primary repair alone, while the laparoscopic group had over 80% of the hernias repaired primarily. Preliminary data on recurrence rates collected thus far shows a trend towards decreased rates of recurrence of hiatal hernia with robotic repair versus laparoscopic (5% versus 23%). Further data collection will yield final recurrence rates as well as subgroup analysis.
The aim of this study is to evaluate the use of the surgical robot in hiatal hernia repair, a subject that has yet to be explored extensively in the current literature. We are hoping to show a decrease in hiatal hernia recurrence rates, which have been disappointing when using a purely laparoscopic technique. We have, to our knowledge, the largest population of patients who underwent robotically-assisted hiatal hernia repair yet to be reported. We feel that the information gathered in this study is important to share with the surgical community at large in order to bolster the amount of evidence-based information available about this relatively new technique for hiatal hernia repair.