Robotic Hiatal Hernia Repair Associated with Higher Morbidity and Readmission Rates Compared to Laparoscopic Repair: 10-Year Analysis from the National Readmissions Database (NRD)

Complications After Paraesophageal Hernia Repair

Paraesophageal hernia repair (PEHR) is a challenging operation both technically and because the affected patient population is typically older with more comorbidities. As a result, PEHR is associated with substantial morbidity. Morbidity and mortality following PEHR vary significantly depending on the acuity of the operation and size of the hernia. In addition to a higher risk for general peri- and postoperative complications there are a variety of other foregut specific complications to consider including, acute perioperative, early, and late reherniation, mesh-related complications, perforation, gastroparesis, pulmonary and insufflation-related complications, among others. This review focuses on the complication-specific data on incidence, recognition etiology and management.

Perioperative outcomes of robotic versus laparoscopic paraesophageal hernia repair: a NSQIP analysis

BACKGROUND

Studies comparing outcomes between robotic and laparoscopic paraesophageal hernia repairs have yielded conflicting results. We sought to analyze early postoperative complications between these approaches using a newly available NSQIP variable indicating robot use.

METHODS

We queried the 2022 ACS NSQIP database for adult patients undergoing elective minimally invasive hiatal hernia repair. Chi-squared and Kruskal-Wallis tests were used to compare cohort characteristics. Logistic, linear, and Cox proportional hazards regression analyses were used to compare perioperative outcomes between the laparoscopic and robotic groups.

RESULTS

We identified 4345 patients who underwent repair using a laparoscopic (2778 patients; 63.9%) or robotic (1567 patients; 36.1%) approach. Most (73.1%) were female, and the median age was 65 (IQR 55, 73). Patients who underwent robotic repair were younger (median age 64 vs 66), had a slightly higher body mass index (BMI; median 30.2 vs 29.9), and were more likely to have hypertension (53.0% vs 48.5%), all p < 0.01. On unadjusted analysis the robotic approach was associated with decreased 30-day mortality (0.0% vs 0.4%, p < 0.01). After adjusting for age, gender, race, BMI, and hypertension, the robotic approach was not associated with increased major complications (5.6% vs 5.1%, AOR 1.13, 95% CI 0.86, 1.49), minor complications (0.9% vs 1.5%, AOR 1.20, 95% CI 0.74, 1.93), or unplanned readmission (6.5% vs 5.5%, AHR 1.17, 95% CI 0.89, 1.54), all p ≥ 0.26. After adjusting for age and hypertension, the robotic cohort had an increased risk of myocardial infarction (AOR 2.53, 95% CI 1.01, 6.33, p = 0.048) and pulmonary embolism (AOR 2.76, 95% CI 1.17, 6.49, p = 0.02), although none resulted in 30-day mortality.

CONCLUSIONS

Robotic and laparoscopic paraesophageal hernia repairs had similar overall complication and readmission rates. The robotic cohort had an increased risk of myocardial infarction and pulmonary embolism but no 30-day mortality. Current data support the use of both robotic and laparoscopic approaches for paraesophageal hernia repair.

Robotic-Assisted and Laparoscopic Bariatric Surgeries Still Have Clinically Comparable Outcomes

PURPOSE

Bariatric surgery is considered the main treatment option for patients with severe obesity. The objective of our study is to compare intra- and postoperative outcomes between the robotic and laparoscopic approaches within the sleeve gastrectomy (SG), duodenal switch (DS), and Roux-en-Y gastric bypass (RYGB).

MATERIALS AND METHODS

The data from the MBSAQIP were collected for patients who underwent SG, DS, and RYGB between 2015 and 2021. The postoperative and procedural outcomes including 30-day morbidity and mortality as well as operation length were analyzed using regression models.

RESULTS

Our analysis included 1,178,886 surgeries with SG comprising the majority (70%) followed by RYGB (28%) and DS (1%). Other than a higher adjusted risk of unplanned reoperation for robotic RYGB (relative risk (RR) 1.07) and a statistically significant higher rate of postoperative wound disruption in robotic SG for robotic surgery (RR 1.56), there were no statistically significant between-approach differences including infection, wound disruption, death, or reoperation for DS, RYGB, or SG. Our data showed no significant difference in anastomotic leak rate between laparoscopic and robotic approaches in either the DS (p = 0.521) or RYGB (p = 0.800) procedures. Across our study period, the median operation lengths decreased significantly per year for both the robotic SG and DS.

CONCLUSIONS

Robotic and laparoscopic bariatric surgical procedures have statistically similar 30-day patient outcomes. Robotic bariatric procedures do have significantly longer median operative times than laparoscopic procedures. The decision to use a robotic approach or laparoscopic approach should be made based upon surgeon experience and possibly cost.

Robotic surgery versus Laparoscopic surgery for anti-reflux and hiatal hernia surgery: a short-term outcomes and cost systematic literature review and meta-analysis

PURPOSE

The objective of this study is to compare the operative time, intraoperative complications, length of stay, readmission rates, overall complications, mortality, and cost associated with Robotic Surgery (RS) and Laparascopic Surgery (LS) in anti-reflux and hiatal hernia surgery.

METHODS

A comprehensive literature search was conducted using MEDLINE (via PubMed), Web of Science and Scopus databases. Studies comparing short-term outcomes and cost between RS and LS in patients with anti-reflux and hiatal hernia were included. Data on operative time, complications, length of stay, readmission rates, overall complications, mortality, and cost were extracted. Quality assessment of the included studies was performed using the MINORS scale.

RESULTS

Fourteen retrospective observational studies involving a total of 555,368 participants were included in the meta-analysis. The results showed no statistically significant difference in operative time, intraoperative complications, length of stay, readmission rates, overall complications, and mortality between RS and LS. However, LS was associated with lower costs compared to RS.

CONCLUSION

This systematic review and meta-analysis demonstrates that RS has non-inferior short-term outcomes in anti-reflux and hiatal hernia surgery, compared to LS. LS is more cost-effective, but RS offers potential benefits such as improved visualization and enhanced surgical techniques. Further research, including randomized controlled trials and long-term outcome studies, is needed to validate and refine these findings.

Evaluation of robot-assisted laparoscopic versus conventional laparoscopic hiatal hernia repair in children

Laparoscopic approach is the gold standard for repairing hiatal hernia (HH). Robotic technology is now widely accepted, but it is rarely used in children with HH. Our aim was to evaluate the clinical effect of robot-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS) in the treatment of HH in children. A retrospective study was carried out in patients undergoing elective robot-assisted laparoscopic or conventional laparoscopic HH repair at a tertiary academic hospital from January 2020 to December 2022, and patients who met the inclusion criteria were included in this study. We compared the characteristics and clinical results of patients to understand the effects of the two surgical methods. Forty-six patients (CLS, group 1, n = 25; RALS, group 2, n = 21) met the inclusion criteria. All operations were performed by one experienced pediatric surgeon. In this study, no significant differences were found in terms of gender, age, weight, size of HH, total operation times, the effective operation time (excluding setup time) and complications between group 1 and group 2. (P = 0.979, P = 0.438, P = 0.265, P = 0.800, P = 0.122, P = 0.427 and P = 0.478, respectively). However, the intraoperative bleeding, the intensive care unit (ICU) admission, postoperative hospital length of stay (LOS) and postoperative fasting time were significantly less for RALS (P = 0.016, P = 0.040, P = 0.035 and P = 0.025, respectively). Meanwhile, the overall charges were significantly higher in group 2 (P < 0.01). Despite higher charges for robotic-assisted HH repair, it is a safe and reliable alternative to CLS and was associated with better outcomes in children.