• J. Am. Coll. Surg. · Nov 2020

    Robotic Approach to Paraesophageal Hernia Repair Results in Low Long-Term Recurrence Rate and Beneficial Patient-Centered Outcomes.

    • William D Gerull, Daniel Cho, Iris Kuo, Saeed Arefanian, Bradley S Kushner, and Michael M Awad.
    • Department of Surgery, Section of Minimally Invasive Surgery, Washington University School of Medicine, St Louis, MO. Electronic address: wgerull@wustl.edu.
    • J. Am. Coll. Surg. 2020 Nov 1; 231 (5): 520-526.

    BackgroundLittle is known regarding important long-term outcomes after robotic paraesophageal hernia (PEH) repairs, such as symptom relief and recurrence rates. The aim of this study was to evaluate the long-term clinical outcomes in a large series of patients undergoing robotic PEH repair.Study DesignThis prospective, IRB-approved study analyzed adult patients who underwent robotic PEH repair, from 2010 to 2014, at a high-volume tertiary academic medical center. Detailed information on patient characteristics, perioperative factors, and long-term patient-reported outcomes for up to 5 years postoperatively were collected. Objective long-term outcomes included radiographic evidence of PEH recurrence at 1, 3, and 5 years postoperatively.ResultsA total of 233 patients underwent robotic PEH repair during the study period-70% were primary, 30% were revisional. Seventy-eight percent of patients (181) had a type III PEH, 21% (49) had a type IV, and 1% (3) had a type II. At 5 years postoperatively, 62% of patients (145 of 233) were available for follow-up, with a radiographic recurrence rate of 9% (13 of 145). Additionally, there was a significant improvement in the GERD-HRQL score at 5 years postoperatively (preoperative: 25.6 ± 8.7, 5-year postoperative, 4.5 ± 1.7, p < 0.01, 95% CI 19.7 to 22.5).ConclusionsThis study represents one of the largest longitudinal robotic foregut surgical databases to date. Our results demonstrate that robotic PEH repair with an experienced surgical team is a safe and effective alternative to laparoscopic repair, with excellent long-term outcomes, including a very low recurrence rate.Copyright © 2020 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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