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Robotic versus laparoscopic surgery for hiatal hernia repair: a systematic literature review and meta-analysis

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Abstract

The number of robotic hiatal hernia repairs (RHHR) is increasing. However, the superiority of this minimally invasive approach remains controversial. The aim of this study was to evaluate the available literature reporting on outcomes of RHHR compared with laparoscopic hiatal hernia repair (LHHR) in adult patients. The design of this systematic review was developed using the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Web of Science, PubMed, the Cochrane Library, and ClinicalTrials.gov databases were searched. Identified publications were reviewed independently by two authors. High heterogeneity was further explored through sensitivity analysis. The primary endpoint was the development of postoperative complications. Secondary endpoints included operation time, intraoperative complications, 30 day readmission rates and length of stay. The analysis was performed using Stata 17.0 software. A total of 7 studies totaling 10078 patients met the inclusion criteria. Five studies included postoperative complications. The postoperative complications rate was 4.25% (302/7111) in the LHHR group, and 3.49% (38/1088) in the RHHR group. Postoperative complications significantly decreased after RHHR compared with LHHR (OR 0.52; 95% CI 0.36 to 0.75, P = 0.000). Three studies involving 2176 patients reported length of hospital stay. In the three studies, the mean Length of hospital stay was 3.2 days in the RHHR group, and 4.2 days in the LHHR group. Length of hospital stay was decreased by a mean of 0.68 days for RHHR compared with LHHR (WMD, − 0.68 days; 95% CI − 1.32 to − 0.03, P = 0.02). There was no significant difference between the RHHR group and the LHHR group regarding operative time, intraoperative complications, and 30 day readmission (P > 0.05). Our research shows that RHHR may be the better option, as the approach decreases postoperative complications and length of hospital stay.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

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Acknowledgements

We want to thank Dr. Michael Hillel Kleinman from Surgical Associates of Houston, Texas Dr. Michael Hillel Kleinman helped Dr. Yunhong Tian dedicate work to the surgical practice and research in Gastrointestinal Surgery.

Funding

This work was supposed by the Foundation of Sichuan Medical Association [S21025], the Cooperative project of Nanchong City with North Sichuan Medical College [20SXQT0321], and the Bureau of Science and Technology Nanchong City [22JCYJPT0007].

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Authors and Affiliations

  1. Department of General Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China

    Longyin Ma, Heng Luo, Zhenguo Gao, Dan Bai, Xiangzhi Qin, Lei Gong & Yunhong Tian

  2. Department of Radiology, Wayne State University, Detroit, MI, 48201, USA

    Takahiro Ouchi & Jiani Hu

  3. School of Medical Clinical, North Sichuan Medical College, Nanchong, 637000, Sichuan, China

    Shien Kou

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Contributions

YT, LM, and HL have made substantial contributions to the design of the work. ZG, and JH interpreted the patients’ data. LM, XQ, and TO was a major contributor in writing the manuscript. YT, SK and LG have drafted the work or substantively revised it. All authors read and approved the final manuscript.

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Correspondence to Yunhong Tian.

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The authors declare that they have no competing interest associated with this manuscript.

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All procedures followed were in accordance with the ethical standards of the ethics committee of Nanchong Central Hospital and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients.

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Written informed consents were obtained from the patients for publication of the two case reports and any accompanying images.

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Ma, L., Luo, H., Kou, S. et al. Robotic versus laparoscopic surgery for hiatal hernia repair: a systematic literature review and meta-analysis. J Robotic Surg 17, 1879–1890 (2023). https://doi.org/10.1007/s11701-023-01636-5

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