Robotic Versus Laparoscopic Paraesophageal Hernia Repair: A Propensity Score-Matched Analysis of Perioperative and Long-Term Outcomes.

BACKGROUND

Minimally invasive surgical (MIS) techniques, including laparoscopic (LAP) and robotic-assisted (ROBOT) approaches, have become the preferred methods for managing paraesophageal hernias (PEH). However, differences in clinical outcomes between these techniques remain an area of active investigation. This study aims to compare symptom resolution and key outcomes, including recurrence rates, between robotic and LAP PEH repair using propensity score matching (PSM) in a high-volume surgical center.

METHODS

Patients who underwent PEH repair between 2000 and 2023 (n = 1834) were retrospectively analyzed. All patients were prospectively enrolled in an IRB-approved database. Among them, those who underwent robotic or LAP PEH repair were specifically selected for comparison. PSM was performed using 1:1 nearest-neighbor matching (ROBOT: n = 128. LAP: n = 128). Patient demographics, hernia characteristics, operative techniques, and postoperative outcomes were assessed. The primary outcomes included symptom improvement, radiographical recurrence, and need for revisional intervention.

RESULTS

After PSM, patients undergoing robotic PEH repair showed no significant difference in symptom improvement compared with the LAP group-particularly for dysphagia, heartburn, and regurgitation-compared with the LAP approach. However, the overall symptom improvement rate was higher in the ROBOT group. Radiographic recurrence was higher in the robotic group in univariable analysis. However, multivariable Cox regression analysis did not identify the surgical approach as an independent predictor of recurrence-free survival. Furthermore, both approaches showed good perioperative outcomes, with similar length of stay and complication rates.

CONCLUSION

Robot-assisted PEH repair was associated with symptom relief and perioperative outcomes comparable to LAP repair. Although radiographic recurrence was higher in the ROBOT group, Cox regression analysis did not identify the surgical approach as an independent predictor of recurrence. These findings suggest that operative technique and patient selection may play an important role in long-term outcomes after PEH repair.