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Safety of robotic assisted laparoscopic recurrent paraesophageal hernia repair: insights from a large single institution experience

  • 2018 SAGES Oral
  • Published:
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Abstract

Background

Laparoscopic repair of recurrent as opposed to primary paraesophageal hernias (PEHs) are historically associated with increased peri-operative complication rates, worsened outcomes, and increased conversion rates. The robotic platform may aid surgeons in these complex revision procedures. The aim of this study 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 to 2017 at a single institution were reviewed. Demographics, use of mesh, estimated blood loss, intra-operative complications, conversion rates, operative time, rates of esophageal/gastric injury, hospital length of stay, re-admission/re-operation rates, recurrence, dysphagia, gas bloat, and pre- and post-operative proton pump inhibitor (PPI) use were analyzed. Analysis was accomplished using Chi-square test/Fischer’s exact test for categorical variables and the Mann–Whitney U test for continuous variables.

Results

There were 298 patients who underwent RAL PEH repairs (247 primary, 51 recurrent). They were followed for a median (interquartile range) of 120 (44, 470) days. There were no significant differences in baseline demographics between groups. Patients in the recurrent PEH group had longer operative times, increased use of mesh, and increased length of hospital stay. They were also less likely to undergo fundoplication. There were no significant differences in estimated blood loss, incidence of intra-operative complications, re-admission rates, incidence of post-operative dysphagia and gas bloat, and incidence of post-operative PPI use. There were no conversions to open operative intervention or gastric/esophageal injury/leaks.

Conclusions

Although repair of recurrent PEHs are historically associated with worse outcomes, in this series, RAL recurrent PEH repairs have similar peri-operative and post-operative outcomes as compared to primary PEH repairs. Whether this is secondary to the potential advantages afforded by the robotic platform deserves further study.

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Author notes

  1. Kendell J. Sowards and Nicholas F. Holton have contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA

    Kendell J. Sowards, Nicholas F. Holton, Ekatarina G. Elliott, John Hall, Kulvinder S. Bajwa, Brad E. Snyder, Todd D. Wilson, Kavita D. Chandwani, Connie L. Klein, Angielyn R. Rivera, Erik B. Wilson, Shinil K. Shah & Melissa M. Felinski

  2. Texas Laparoscopic Consultants, Houston, TX, USA

    Sheilendra S. Mehta

  3. Health First Medical Group, Rockledge, FL, USA

    Peter A. Walker

  4. Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA

    Shinil K. Shah

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Correspondence to Shinil K. Shah.

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Disclosures

Drs. Brad Snyder and Sheilendra Mehta have received teaching honoraria from Intuitive Surgical. Dr. Todd Wilson is a consultant for Bard, EndoEvolution, and Olympus. Drs. Peter Walker and Shinil Shah have received research grant support from Medigus and Neosurgical. Dr. Shinil Shah has received research grant support from Intuitive Surgical. Dr. Erik Wilson has received teaching honoraria from Intuitive Surgical, Olympus, Gore, Apollo, and Ethicon. Kendell Sowards, Ekatarina Elliott, John Hall, Kulvinder Bajwa, Kavita Chandwani, Melissa Felinski, Connie Klein, Angielyn Rivera, and Nicholas Holton have no conflicts of interest or financial ties to disclose.

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Sowards, K.J., Holton, N.F., Elliott, E.G. et al. Safety of robotic assisted laparoscopic recurrent paraesophageal hernia repair: insights from a large single institution experience. Surg Endosc 34, 2560–2566 (2020). https://doi.org/10.1007/s00464-019-07291-y

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