Robotic Laparoscopic Transdiaphragmatic Repair of Large Hiatal Hernias

作     者：Farid Gharagozloo Mark Meyer Farid Gharagozloo;Mark Meyer

作者机构：University of Central Florida Orlando USA 

出 版 物：《World Journal of Cardiovascular Surgery》 (心血管外科国际期刊（英文）)

年 卷 期：2022年第12卷第4期

页      面：85-104页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Robotic Hiatal Hernia Recurrence 

摘      要：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.