Matthew L Dong, MD, MPh, Kevin El-Hayek, MD. Cleveland Clinic
Introduction: Repair of Type IV paraesophageal hernias remains a technically challenging operation. Use of robot assistance in selected cases allows for easier use of intracorporeal suturing, which may allow for improved mesh fixation without the need for a laparotomy.
Results: The patient is a 60-year-old female with a retrosternal Type IV paraesophageal hernia repair, with symptoms of substeral chest pain and gastroesophageal reflux. She has significant medical comorbidities including alcoholic cirrhosis and portal hypertension with variceal disease. She underwent robot-assisted repair of her paraesophageal hernia, utilizing a biologic mesh underlay, with gastropexy.
Conclusion: This case demonstrates utilization of the robot to provide a platform for intraabdominal suturing to secure mesh in a complex hernia repair on a patient with significant medical comorbitiies, sparing the morbidity of a laparotomy.