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Short-term outcome after robot-assisted hiatal hernia and anti-reflux surgery—is there a benefit for the patient?

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Abstract

Purpose

The robotic system was introduced to overcome the technical limitations of conventional laparoscopy. For complex oncological operations, it appears to offer further advantages. With regard to hiatal hernia repair, its role has yet to be determined.

Methods

All consecutive patients who received elective laparoscopic or robot-assisted hiatal hernia repair at a single institution between January 2016 and July 2020 were retrospectively evaluated. We compared both techniques with particular focus on their short-term outcome. A propensity score-matched comparison considering clinical and surgical covariates was also performed between the two groups.

Results

140 patients were included, and 55 (39.3%) underwent a robot-assisted procedure. The baseline demographics and the frequency of previous abdominal operations were comparable for both groups. The size of the hiatal hernia did not differ significantly between the groups (p = 0.06). The mean operative time was significantly longer for the robot-assisted procedure (149 vs. 125 min; p < 0.01) but decreased markedly during the study period. By contrast, no significant differences were observed in terms of conversion rate (p = 1.0) and blood loss (p = 0.25). Likewise, the postoperative morbidity was comparable for both groups (10.9 vs. 12.9; p = 0.79). The hospital length of stay was not significantly different between the laparoscopic and robotic group (4.0 vs. 3.6 days; p = 0.2). After propensity score-matching, 48 patients were identified for each group. Except for the operative time, no other significant differences were found. Thus, the results of the univariate analysis were confirmed.

Conclusion

Our initial results failed to demonstrate a clear advantage of the robotic technique in patients with refractory gastroesophageal reflux disease and/or symptomatic hiatal hernias.

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Data availability

Data and material are available at frankbenedix@gmx.de

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Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany

    Frank Benedix, Steffi Peglow, Linda Marie Gstettenbauer & Roland Croner

  2. StatConsult GmbH, Halberstädter Strasse 40a, 39112, Magdeburg, Germany

    Daniela Adolf

Authors
  1. Frank Benedix
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  2. Daniela Adolf
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  3. Steffi Peglow
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  4. Linda Marie Gstettenbauer
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  5. Roland Croner
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Contributions

Study conception and design: Benedix F, Peglow S. Acquisition of data: Benedix F, Gstettenbauer L. Analysis and interpretation of data: Adolf D, Benedix F, Gstettenbauer L. Drafting of manuscript: Croner R, Benedix F. Critical revision of manuscript: Croner R, Adolf D, Peglow S.

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Correspondence to Frank Benedix.

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Conflict of interest

AD (StatConsult GmbH) received fees from the University Hospital Magdeburg for statistical support. All other authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Benedix, F., Adolf, D., Peglow, S. et al. Short-term outcome after robot-assisted hiatal hernia and anti-reflux surgery—is there a benefit for the patient?. Langenbecks Arch Surg 406, 1387–1395 (2021). https://doi.org/10.1007/s00423-020-02051-2

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  • DOI: https://doi.org/10.1007/s00423-020-02051-2

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