Nicholas F Holton, BA1, Melissa M Felinski, DO1, Sheilendra S Mehta, MD1, Kulvinder S Bajwa, MD1, Brad E Snyder, MD1, Todd D Wilson, MD1, Peter A Walker, MD2, Kavita D Chandwani, MD, DrPH1, Connie L Klein, NP1, Angielyn Rivera1, Erik B Wilson, MD1, Shinil K Shah, DO1. 1McGovern Medical School, UT Health, 2Health First Medical Group
Background: Laparoscopic repair of recurrent as opposed to primary paraesophageal hernias (PEH) are associated with increased peri-operative complication rates, worse outcomes, and increased conversion rates. The robotic platform may aid surgeons in these complex revisional procedures. Our aim was to compare the outcomes of patients undergoing robotic assisted laparoscopic (RAL) repair of recurrent as opposed to primary PEHs.
Methods: Patients undergoing RAL primary and recurrent PEH repairs from 2009-2017 performed at a single institution were reviewed. Demographics, use of mesh, estimated blood loss, intra-operative complications, conversion rates, operative time, rates of esophageal/gastric leak, hospital length of stay, readmission/re-operation rates, recurrence, dysphagia, gas bloat, and pre- and post-operative PPI use were analyzed. Analysis was performed using the appropriate parametric or non-parametric analysis (continuous data) or Pearson’s Chi-squared test or Fisher’s exact test (categorical data).
Results: There were 325 patients who underwent RAL PEH repairs (265 primary, 60 recurrent) and were followed for a median (range) of 121 (5-2592) days. In the recurrent PEH group, patients had a median (range) of 1 (1-3) previous PEH operations. There were no differences in baseline demographics (age, body mass index, American Society of Anesthesiologists score, gender, insurance status, marital status, race/ethnicity, and pre-operative PPI use) between the groups. More patients in the recurrent PEH group had previous abdominal surgery (96.7% versus 68.3%, p<0.001), were more likely to have mesh placed (50% versus 34%, p=0.03), had longer operative times (170.4 versus 137.0 minutes, p=0.0006) and had longer hospital length of stay (66.2 hours versus 43.8 hours, p=0.001). Intra-operative complications, estimated blood loss, readmission and re-operation rates, recurrence, post-operative dysphagia and gas-bloat, and post-operative PPI use were not significantly different between the groups. There were no conversions or gastric/esophageal leaks in either group.
Conclusions: Although associated with longer operative times and hospital length of stay, RAL recurrent PEH repairs have similar perioperative and post-operative outcomes as compared to primary PEH repairs. Whether this is secondary to potential advantages afforded by the robotic platform deserves further study.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88155
Program Number: S053
Presentation Session: Robotics 1 Session
Presentation Type: Podium
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