Introduction:Although laparoscopic
Nissen fundoplication is the most common procedure for the repair for hiatal
hernia (HH) repair, HH recurrence due to breakdown of the hiatoplasty has been
reported as a common mechanism of failure after primary repair. Left
transthoracic anatomic and physiologic repair (AFR) of HH is associated with
lower incidence of leak and reoperation but greater morbidity. Adopting the
transthoracic approach to a robotic laparoscopic platform may represent the
ideal approach to the repair of HH. This study reviews the results of this
technique. Methods: A retrospective review was performed on patients who
had robotic AFR (RAFR) of large HH. All patients received the previously
validated Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire preoperatively
and postoperatively. Objectively, symptoms were graded using the Visick Scale.
Recurrence was defined as greater than 2 cm or 10% of the stomach above the
diaphragm detected by either CT, esophagogram or endoscopy. The preoperative
data was compared to the results at 2 years. Results: 396 patients underwent
RAPR. The Median GERD-HRQL score was 42 (range 38-45) preoperatively and 6 (range 0-14) at two years (p < 0.05). Preoperatively 87% of patients were
graded as Visick IV. At two years, 95% were graded as Visick I. HH recurrence
occurred in 4/396 patients (1%). Conclusion: RAFR of HH is associated
with excellent symptom relief and low recurrence rate. RAFR should be
considered when deciding on what operation to perform in patients with large
paraesophageal hiatal hernias.
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