Robot Assisted Giant Hiatal Hernia Repair

Mohammed Kalan, MD, Mark Meyer, MD, Barbara Tempesta, CRNP, Marc Margolis, MD, Eric Strother, CSA, Farid Gharagozloo, MD

The Washington Institute of Thoracic and Cardiovascular Surgery and the Washington Surgical Institute at The George Washington University Hospital, Washington, DC. The University of Arizona College of Medicine, Tucson, AZ

INTRODUCTION: Conventionally, the surgical approach to these large hernias has been through a laparotomy, thoracotomy or laparoscopy with the use of a hiatal patch. Historically, independent of the approach, the results of surgical repair have been disappointing. By virtue of three-dimensional visualization and greater instrument maneuverability, the robot assisted laparoscopic approach can facilitate the complete dissection of the intrathoracic stomach and primary repair of the giant hiatal hernias.

METHODS: Over 16 months, 8 patients with an intrathoracic upside down stomach and a giant hiatal hernia underwent a robotic laparoscopic approach. The robot was introduced through 4 trocars. The intra thoracic dissection of the hernia sac and the stomach was performed robotically. The right and left crus were dissected, hiatal closure was performed primarily, using 0 Ethibond suture with pledgets of vicryl mesh. A concomitant anti-reflux procedure was performed in all patients. The success of the procedure was assessed by intra-operative endoscopy and post-operative esophagram. Subjective symptoms were assessed by a symptom interview. Objective symptoms were assessed by third party Viscik grading.

RESULTS: There were 2 males and 6 females with a mean age 72 years. Mean operative time was 199 +/- 47 min. The procedure was assessed to be successful in all patients based on endoscopy and esophagram. All patients were asymptomatic and were graded as Viscik I at 1 day, 2 weeks, and 10 months after surgery. No recurrences were noted.

CONCLUSION: Robotics facilitates a complete dissection of the hernia sac and reduction of the intrathoracic stomach in patients with giant hiatal hernias.

Session: Poster Presentation

Program Number: P635

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