Z Gastroenterol 2017; 55(08): e57-e299
DOI: 10.1055/s-0037-1605311
Kurzvorträge
Klinische Praxis und Versorgungsforschung
Robotik und digitale Medizin: Freitag, 15 September 2017, 11:30 – 12:42, Barcelona/Forschungsforum 5
Georg Thieme Verlag KG Stuttgart · New York

Robotic hiatal hernia repair: A single-institution experience

N Niclauss
1   Geneva University Hospitals, Viszeral Surgery, Geneva, Schweiz
,
MK Jung
1   Geneva University Hospitals, Viszeral Surgery, Geneva, Schweiz
,
V Belfontali
1   Geneva University Hospitals, Viszeral Surgery, Geneva, Schweiz
,
A Vogel
1   Geneva University Hospitals, Viszeral Surgery, Geneva, Schweiz
,
ME Hagen
1   Geneva University Hospitals, Viszeral Surgery, Geneva, Schweiz
,
SP Mönig
1   Geneva University Hospitals, Viszeral Surgery, Geneva, Schweiz
,
P Morel
1   Geneva University Hospitals, Viszeral Surgery, Geneva, Schweiz
› Author Affiliations
Further Information

Publication History

Publication Date:
02 August 2017 (online)

 

Objectives:

Hiatal hernia repair is a standardized procedure performed by robotic approach since 2006 in our institution. Within this study we evaluated perioperative outcomes, learning curve of the robotic approach and recurrence rate in patients undergoing robotic hiatal hernia repair.

Methods:

All patients who underwent robotic hiatal hernia repair from April 2006 until June 2016 were prospectively included. The surgical technique was the same for all patients and counts three steps: hernia reduction, crural repair with non-absorbable stitches with or without mesh and fundoplication. Postoperative CT-scan or endoscopy were performed in symptomatic patients to exclude recurrence.

Results:

82 patients were included (43.9% men, 56.1% women). Mean age was 53.2 ± 14.7 years and mean BMI was 26.7 ± 4.1 kg/m2. 7 (8.5%) patients had an ASA score of 1, 70 (85.4%) of 2 and 5 (6.1%) of 3. 53.5% of all patients had previous abdominal surgery. 83% of all patients presented with persistent typical symptoms of gastro-oesophageal reflux despite well-conducted antisecretory treatment. 17% presented with atypical signs or symptoms. 32.9% had oesophagitis at upper endoscopy and 7.3% were diagnosed with Barrett disease. Only 54% of all patients had preoperative pH monitoring and 40.5% had pathological DeMeester score. 80 Nissen, 1 Dor and 1 Toupet procedure were performed with 3 associated Heller myotomies. Mean docking time was of 8.3 ± 6.8 min. Mean operative time was 212 ± 79.3 min. 3 (3.6%) procedures needed conversion to open surgery and 2 (2.4%) intraoperative complications occurred. Postoperatively (30 days) we recorded 29% Clavien I-II, 7.3% Clavien III (1 lower oesophageal stenosis needing pneumatic dilatation and redo surgery, 1 pyloric spasm needing botulinum toxin injection, 3 pneumothorax needing pleural drainage, 1 slipped wrap needing redo surgery) and no Clavien IV-V complications. Mean hospital stay was 6.6 ± 3.9 days. During median long-term follow-up of 52.2 (range 6 – 128) months, 1 (1.2%) slipped wrap needing redo surgery and 8 (9.7%) recurrent reflux occurred.

Conclusions:

Our experience with robotic approach for hiatal hernia repair has shown feasibility of a standardized technique with no major complications and low recurrence rate.