Sharona B Ross, MD, Alexander S Rosemurgy, MD, Danielle K Craigg, MD, Miguel Castro, Melissa Gonzalez, Iswanto Sucandy, MD. Digestive Health Institute Florida Hospital Tampa
Introduction: The repairs of a type IV giant/paraesophageal hernias and failed antireflux fundoplications are difficult, often exacerbated by operating through a reoperative field. With an experience of over 2,500 anti-reflux operations and with increasing penetrance of robotic surgery into our practice, we sought to document our outcomes with robotic redo hiatal hernia repairs/fundoplications and robotic repairs of type IV giant/paraesophageal hernias to evaluate the robotic approach. We hypothesize that the robotic approach is a safe and effective method to utilize in challenging fundoplications.
Methods: With IRB approval, 56 patients who had type IV giant/paraesophageal hernias (N=24) or failed antireflux fundoplications (N=32) were prospectively followed. Outcomes, including length of stay (LOS), estimated blood loss (EBL), operative time, intraoperative and postoperative complications, and conversions to ‘open’ operations were evaluated. Data are presented as median (mean + SD). Significance was accepted with 95% probability.
Results: The 56 patients had a BMI of 26 (25 ± 3) Kg/M2 and age of 67 (66 ± 11) years. With their operations, EBL was 25 (53 ± 75) mL, median operative time was 194 mins (203 ± 78), and LOS was 1 (2 ± 2) day; operative duration decreased progressively with experience (p=0.023, Figure). 4 patients had intraoperative complications (4 gastrostomies) and only four patients had postoperative complications (2 capnothorax [Clavian Grade 2b], 2 respiratory decompensation due to smoking/COPD [Clavien Grade 2a]). No patients were converted to an ‘open” operation. There were no differences between patients undergoing repairs of type IV giant/paraesophageal hernias or failed antireflux fundoplications, except all gastrostomies occurred (without consequence, Grade 2 Delphi classification) in those undergoing robotic repairs of failed antireflux fundoplications.
Conclusions: The robotic approach to repairing type IV giant/paraesophageal hernias and failed antireflux fundoplications seems easier than a laparoscopic approach; the redo operations are inherently more difficult. EBL, LOS, and frequency of notable complications were commendable and operative time was permissible and significantly decreased with experience. For these difficult operations a robotic approach will be our choice.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95705
Program Number: P661
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster